Should albumin be used to correct hypoalbuminaemia in the critically ill

Abstract

Albumin is a very important protein in the human body. It has a variety of functions which are responsible for homeostasis. In the critically ill patient hypoalbuminemia is usually present. It is mainly a result of an increased catabolism, loss through gut and kidneys, dilution due to massive infusions, redistribution due to increased vascular permeability. Until recently, the decreased plasma concentration of albumin was immediately treated. It was believed that keeping serum albumin within acceptable values was important due to its favourable functions such as: maintaining an adequate oncotic pressure gradient; being an important binding and transport protein; its anticoagulant, antiaggregant and antioxidant properties as well as its integral role in normal protein metabolism. Some study results have recently brought about a hesitation in albumin infusion due to belief that it may be harmful and cause an increase in death rate in the critically ill. However, albumin has been used widely around the world for more than 60 years and has an excellent long term safety profile. Whether it is safe to use albumin as treatment for hypoalbuminemia in the critically ill, remains to be proved by future analyses and studies which are eagerly awaited by intensivists. Meanwhile, the existing evidence is not conclusive enough, so as to ban albumin from use.