Use of Intravenous Albumin: A Guideline from the International Collaboration for Transfusion Medicine Guidelines.
Callum J., Skubas NJ., Bathla A., Keshavarz H., Clark EG., Rochwerg B., Fergusson D., Arbous S., Bauer SR., China L., Fung M., Jug R., Neill M., Paine C., Pavenski K., Shah PS., Robinson S., Shan H., Szczepiorkowski ZM., Thevenot T., Wu B., Stanworth S., Shehata N., ICTMG Intravenous Albumin Guideline Group None.
BACKGROUND: Albumin is commonly employed across a wide range of clinical settings to improve hemodynamics, facilitate fluid removal, and manage complications of cirrhosis. The International Collaboration for Transfusion Medicine Guidelines developed guidelines for the use of albumin in patients requiring critical care, undergoing cardiovascular surgery, kidney replacement therapy, or experiencing complications of cirrhosis. METHODS: Co-chairs oversaw the guideline development process and the panel included researchers, clinicians, methodologists, and a patient representative. The evidence informing this guideline arises from a systematic review of randomized clinical trials and systematic reviews, in which multiple databases were searched (inception to November 23, 2022). The panel reviewed the data and formulated the guideline recommendations using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The guideline was revised after public consultation. RESULTS: The panel made 14 recommendations on albumin use in adult critical care (3 recommendations), pediatric critical care (1 recommendation), neonatal critical care (2 recommendations), cardiovascular surgery (2 recommendations), kidney replacement therapy (1 recommendation), and complications of cirrhosis (5 recommendations). Of the 14 recommendations, 2 had moderate certainty of evidence, 5 had low certainty of evidence, and 7 had very low certainty of evidence. Two of the 14 recommendations suggested conditional use of albumin for patients with cirrhosis undergoing large volume paracentesis or with spontaneous bacterial peritonitis. Twelve of 14 recommendations did not suggest albumin use in a wide variety of clinical situations where albumin is commonly transfused. CONCLUSIONS: There are currently few evidence-based indications that support the routine use of albumin in clinical practice to improve patient outcomes. This guideline provides clinicians with actionable recommendations on the use of albumin.