Albumin for fluid resuscitation: Implications of the Saline Versus Albumin Fluid Evaluation

Analysis of Morbidity in Liver Transplant Recipients following Human Albumin Supplementation: A Retrospective Pilot Study

Objectives

To assess incidence of morbidity (ie, documented infection, acute renal failure, acute graft rejection, acute cardiovascular events, and hospital read-mission rates) 6 months following liver transplantation using linear regression as a function of cumulative albumin dose.

Design

Retrospective chart review.

Setting

A 473-bed tertiary care teaching facility with a solid-organ transplantation center.

Patients

Forty liver transplant recipients examined from January 1 to December 31, 2003.

Measurements and Results

Data from 40 liver transplant recipients were collected. Mean albumin dose administered was 190.9 ± 162.3 g. No statistical differences were identified in patients receiving less than 140 g (n = 20) or more than 140 g (n = 20) with respect to demographic data other than gender and ethnicity. The mean APACHE III (Acute Physiology and Chronic Health) score was 69.7 ± 24.3. Approximately 70 episodes of morbidity and 23 readmissions were observed. Regardless of the APACHE III score, albumin was associated with increased overall morbidity and cardiovascular complications. Liver transplant recipients receiving more than 140 g had a longer hospital stay (14 vs 8 days, P = .025) and intensive care unit stay (6 vs 3 days, P = .051) than patients receiving 140 g or less. No correlation with risk of acute rejection was seen with albumin or tacrolimus.

Conclusion

Albumin supplementation among liver transplant recipients was associated with a significant risk for cardiovascular complications and overall number of complications regardless of APACHE III score. Future prospective studies are needed to further define the potential risk for complications in this patient population.

Surviving sepsis in low-income and middle-income countries: new directions for care and research

Sepsis is a disorder characterised by systemic inflammation secondary to infection. Despite recent progress in the understanding and treatment of sepsis, no data or recommendations exist that detail effective approaches to sepsis care in resource-limited low-income and middle-income countries (LMICs). Although few data exist on the burden of sepsis in LMICs, the prevalence of HIV and other comorbid conditions in some LMICs suggest that sepsis is a substantial contributor to mortality in these regions. In well-resourced countries, sepsis management relies on protocols and complex invasive technologies not widely available in most LMICs. However, the key concepts and components of sepsis management are potentially translatable to resource-limited environments. Health personnel in LMICs should be educated in the recognition of sepsis and the importance of early and appropriate antibiotic use. Simple and low-cost standardised laboratory testing should be emphasised to allow accurate diagnosis, prognosis, and monitoring of treatment response. Evidence-based interventions and treatment algorithms tailored to LMIC ecology and resources should thus be developed and validated.

Adjunctive measures for treating surgical infections and sepsis

The history of adjunctive treatments for severe sepsis has been fraught with more failures than successes. To date, there have been few interventions that have been demonstrated to be efficacious by multiple large, well-designed, multicenter randomized clinical trials. However, recent research into treatment strategies using drotrecogin alfa (activated), effective blood glucose management, early goal-directed therapy, protocolization of care, and intensivist management has demonstrated positive results. Further research is being conducted to verify the success of these initial trials. This article summarizes some of the available adjunctive treatments for severe sepsis.