#Albumin Should Be Remembered When Patients With #SepticShock Are Resuscitated
“Although no significant difference in 28-day mortality rate or 90-day mortality rate was observed between the use of albumin and #crystalloids, #colloids appeared to be more effective than crystalloids in stabilizing hemodynamic end points”
I couldn't agree more. Sometimes you have to find what to do at the moment. It is safe and may help.
https://journal.chestnet.org/article/S0012-3692(23)00654-2/fulltext
@BakkeHK @rombarthelemy Assuming the glycocalyx is intact, that's probably true?
I do sometimes wonder how much of critical care is treating the patient vs treating the provider. :)
@razvan @BakkeHK Not at all. The purpose of using #albumin in #SepticShock is precisely to prevent or mitigate #glycocalyx damage. If oncontic pressure gradient was the purpose, any synthetic colloid would do the job (actually, they won’t, because of the altered endothelial layer, as you suggested)
https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-020-00697-1
https://link.springer.com/article/10.1007/s00134-022-06740-y
The endothelial glycocalyx comprises a complex layer of membrane-bound proteoglycans, secreted glycosaminoglycans, glycoproteins, glycolipids and bound plasma proteins such as albumin and antithrombin associated with the endothelial surface. The glycocalyx plays an important role in vascular homeostasis, regulating vascular permeability and cell adhesion, and acts as a mechanosensor for hemodynamic shear stresses; it also has antithrombotic and anti-inflammatory functions. Plasma proteins such as albumin are physiologically bound within the glycocalyx, thus contributing to stability of the layer. Albumin is the major determinant of plasma colloid osmotic pressure. In addition, albumin transports sphingosine-1-phosphate which has protective endothelial effects, acts as a free radical scavenger, and has immunomodulatory and anti-inflammatory effects. This review examines the physiological function of the endothelial glycocalyx and the role of human albumin in preserving glycocalyx integrity and the microcirculation.
@rombarthelemy @BakkeHK Sorry, that was just a general comment on the psychological effect, not trying to argue against #albumin; quite the opposite!
Very interesting article and thank you for sharing it! Do you have any thoughts on timing and benefit, purely in terms of #glycocalyx damage?
Is the benefit of albumin constant regardless of the degree of existing glycocalyx damage? Or is there a point where, if the disruption is severe enough, it stops being effective?
@razvan @BakkeHK I agree that some intervention may have a psychological effect (main positive psy effect: prevent physician ton perform other deleterious intervention)
I also agree that some glycocalyx damage might be too advanced to be repaired, and that some patient diagnosed as septic shock might not have significant glycocalyx damage
Promising leads
Romain Barthélémy
Håkon Bakke
Razvan Azamfirei