The Efficacy of Albumin with Diuretics in the Mechanically Ventilated Patients with Hypoalbuminemia: Systematic Review and Meta-Analysis

Abstract

\n Background Hypoalbuminemia is associated with fluid overload, the development of acute respiratory distress syndrome, and mortality. Co-administration of albumin and diuretics for treatment of patients with hypoalbuminemia is expected to increase urinary output, without hemodynamic instability, and improve pulmonary function; however, these effects have not been systematically investigated. Here, we aimed to clarify the benefits of co-administration of albumin and diuretics for mechanically ventilated patients.MethodsWe searched for randomized, placebo-controlled trials that investigated the effects of co-administration of albumin and diuretics compared with placebo and diuretics, in mechanically ventilated patients with hypoalbuminemia. We searched these trials via the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via PubMed and EMBASE. Primary outcomes were hypotensive events after intervention, all-cause mortality, and the length of mechanical ventilation. Secondary outcomes were improvement in the ratio of partial pressure arterial oxygen and fraction of inspired oxygen (P/F ratio) at 24 h, total urine output (mL/d), and the clinical requirement of renal replacement therapy (RRT).ResultsAmong 1574 records identified, we included three studies for quantitative analysis. The results of albumin administration were as follows: hypotensive events [risk ratio (RR) -1.05 (95% confidence interval (CI): 0.15 to 0.81], all-cause mortality [RR 1.0 (95% CI: 0.45 to 2.23], the length of mechanical ventilation in days [mean difference (MD) -1.05 (95% CI: -3.35 to 1.26)], improvement of P/F ratio [RR 2.83 (95% CI: 1.42 to 5.67)]. None of the randomized controlled trials reported the total urine output, whereas one reported that no participants required RRT. Adverse events were not reported during the trials. The certainty of evidence was low (in the hypotensive events after intervention, all-cause mortality) to moderate (in the length of mechanical ventilation in days, improvement of P/F ratio, clinical requirement of RRT, and adverse events).ConclusionsAlthough this treatment combination reduced the number of days for which mechanical ventilation was required, it did not reduce the all-cause mortality at 30 days. Taken together, co-administration of albumin and diuretics may reduce hypotensive events and improve the P/F ratio at 24 h.