Albumin for sepsis-related peripheral tissue hypoperfusion,Critical Care

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Albumin for sepsis-related peripheral tissue hypoperfusion
Critical Care ( IF 15.1 ) Pub Date : 2024-03-14 , DOI: 10.1186/s13054-024-04846-x
Mingqiang Wang , Lin Zhong

We read with interest the manuscript by Gabarre et al. regarding albumin infusion [1]. Here, I believe there is a minor issue that needs clarification.

The sample size in each group of this study is quite small. On this basis, there is a difference in the need for vasopressor between the two groups, although it did not reach statistical significance (0.4 vs. 0.7, P = 0.06). Considering that all patients received 20 mg/kg of saline, could this lead clinicians to perceive poorer response to saline in this subset of patients, prompting additional selection of albumin?

In our clinical practice, we frequently supplement albumin instead of crystalloids for patients who exhibit a poor response to crystalloids therapy [2]. It is challenging to precisely define what constitutes a poor response to crystalloids, but often our intuition, along with hourly assessments showing non-decrease in vasopressor requirements after continuous crystalloids infusion, informs us that these patients may no longer benefit from saline and that albumin could be a viable alternative.

Therefore, it cannot be simply assumed that “The decision to administer saline or albumin, left to the discretion of the attending physician, may pose a confounding factor.” Instead, it is possible that clinicians, recognizing a poor response to saline in certain patients, with a slow reduction in vasopressor usage, chose to administer albumin as an alternative.

Performing further analysis after Inverse Probability of Treatment Weighting for vasopressor usage or conducting a well-designed RCT might yield more accurate conclusions.

None.

Gabarre P, Desnos C, Morin A, et al. Albumin versus saline infusion for sepsis-related peripheral tissue hypoperfusion: a proof-of-concept prospective study. Crit Care. 2024;28(1):43.
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Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021;47(11):1181–247.
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Author notes

Mingqiang Wang and Lin Zhong have contributed equally to this work

Authors and Affiliations

Department of Critical Care Medicine, Zhengzhou University People’s Hospital, Henan University People’s Hospital, Zhengzhou, China
Mingqiang Wang
Henan Key Laboratory for Critical Care Medicine, Zhengzhou Key Laboratory for Critical Care Medicine, Henan Provincial People’s Hospital, Zhengzhou, China
Mingqiang Wang
Department of Critical Care Medicine, The First People’s Hospital of Pinghu, Pinghu, China
Lin Zhong

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MQW, LZ participated in the discussion and wrote the manuscript. All authors read and approved the final manuscript.

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Correspondence to Mingqiang Wang.

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