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Abedi F, Zarei B, Elyasi S. Albumin: a comprehensive review and practical guideline for clinical use. Eur J Clin Pharmacol 2024; 80:1151-1169. [PMID: 38607390 DOI: 10.1007/s00228-024-03664-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 03/04/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE Nowadays, it is largely accepted that albumin should not be used in hypoalbuminemia or for nutritional purpose. The most discussed indication of albumin at present is the resuscitation in shock states, especially distributive shocks such as septic shock. The main evidence-based indication is also liver disease. In this review, we provided updated evidence-based instruction for definite and potential indications of albumin administration in clinical practice, with appropriate dosing and duration. METHODS Data collection was carried out until November 2023 by search of electronic databases including PubMed, Google Scholar, Scopus, and Web of Science. GRADE system has been used to determine the quality of evidence and strength of recommendations for each albumin indication. RESULTS A total of 165 relevant studies were included in this review. Fluid replacement in plasmapheresis and liver diseases, including hepatorenal syndrome, spontaneous bacterial peritonitis, and large-volume paracentesis, have a moderate to high quality of evidence and a strong recommendation for administering albumin. Moreover, albumin is used as a second-line and adjunctive to crystalloids for fluid resuscitation in hypovolemic shock, sepsis and septic shock, severe burns, toxic epidermal necrolysis, intradialytic hypotension, ovarian hyperstimulation syndrome, major surgery, non-traumatic brain injury, extracorporeal membrane oxygenation, acute respiratory distress syndrome, and severe and refractory edema with hypoalbuminemia has a low to moderate quality of evidence and weak recommendation to use. Also, in modest volume paracentesis, severe hyponatremia in cirrhosis has a low to moderate quality of evidence and a weak recommendation. CONCLUSION Albumin administration is most indicated in management of cirrhosis complications. Fluid resuscitation or treatment of severe and refractory edema, especially in patients with hypoalbuminemia and not responding to other treatments, is another rational use for albumin. Implementation of evidence-based guidelines in hospitals can be an effective measure to reduce inappropriate uses of albumin.
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Affiliation(s)
- Farshad Abedi
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, P.O. Box, Mashhad, 91775-1365, Iran
| | - Batool Zarei
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, P.O. Box, Mashhad, 91775-1365, Iran.
| | - Sepideh Elyasi
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, P.O. Box, Mashhad, 91775-1365, Iran.
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Beg M, Maji A, Aktara MN, Kundu S, Paria S, Shit B, Dhal A, Islam MM, Hossain M. Multi-spectroscopic and thermodynamic profiles on HSA binding of Cassia fistula leaf based potential antibacterial and anticancer silver nanoparticles. J Biomol Struct Dyn 2023:1-13. [PMID: 37990582 DOI: 10.1080/07391102.2023.2283148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/06/2023] [Indexed: 11/23/2023]
Abstract
Here, a simple, one step, lucrative and green synthesis of Cassia fistula leaf extract inspired antibacterial silver nanoparticles (CF-SNPs) was provided. Characterization of these CF-SNPs were achieved by using various spectroscopic techniques for instance Ultraviolet Visible (UV-Vis) Spectroscopy, Fourier-Transform Infrared (FTIR) Spectroscopy, Dynamic Light Scattering (DLS), Transmission Electron Microscopy (TEM) and Energy Dispersive X-ray (EDX). The effective antibacterial action of the CF-SNPs was checked against Escherichia coli (E. Coli) DH5-Alpha where MIC was 1.6 nM. Anticancer dynamism of the CF-SNPs was also tested in opposition to skin melanoma, A375 cell lines in which 4.4 nM was IC50. The binding proneness of HSA towards CF-SNPs was investigated by means of UV-Vis Spectroscopy, Fluorescence Spectroscopy, Time Resolved Fluorescence Spectroscopy, Circular Dichroism (CD) Spectroscopy, Dynamic Light Scattering, and Isothermal Titration Colorimetry (ITC). CD spectroscopy established minor secondary structural exchange of HSA in HSA-CF-SNPs complex. ITC and Time Resolved Fluorescence Spectroscopy verified the static type quenching mechanism involved in HSA-CF-SNPs complex. The binding constant was 3.45 × 108 M-1 at 298.15K from ITC study. The thermodynamic parameters showed that the interaction was occurred spontaneously by the hydrophilic forces and hydrogen bonding.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Maidul Beg
- Department of Chemistry, Vidyasagar University, Midnapore, India
| | - Anukul Maji
- Department of Chemistry, Vidyasagar University, Midnapore, India
| | - Mt Nasima Aktara
- Department of Chemistry, Vidyasagar University, Midnapore, India
| | - Somenath Kundu
- Department of Chemistry, Vidyasagar University, Midnapore, India
| | - Samaresh Paria
- Department of Chemistry, Vidyasagar University, Midnapore, India
| | - Basudev Shit
- Department of Chemistry, Vidyasagar University, Midnapore, India
| | - Asima Dhal
- Department of Chemistry, Vidyasagar University, Midnapore, India
| | | | - Maidul Hossain
- Department of Chemistry, Vidyasagar University, Midnapore, India
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Khademi S, Heirany F, Jouybar R, Dehghanpisheh L, Ghazinoor M, Mehr LS. Effect of albumin usage during cardiopulmonary bypass on postoperative acute kidney injury in cardiac surgery patients: A historical cohort study. Ann Card Anaesth 2023; 26:288-294. [PMID: 37470527 PMCID: PMC10451135 DOI: 10.4103/aca.aca_84_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/27/2022] [Accepted: 09/26/2022] [Indexed: 07/21/2023] Open
Abstract
Introduction Acute kidney injury (AKI) after cardiac surgery is a common and serious postoperative complication and is associated with an increased risk of mortality, morbidity, length of hospital stay, and costs. We evaluated the effect of albumin usage on postoperative AKI in patients who underwent on-pump Coronary Artery Bypass Graft Surgery (CABG). Methods This non-randomized cohort study was conducted on data from adult patients who underwent elective CABG, from March of 2015 to March of 2019. We assessed two groups of patients including the albumin (who received 50cc albumin 20% in priming solution) and the non-albumin groups. We recorded demographic data, medical history, and preoperative laboratory data. We compared postoperative changes in serum creatinine (Cr), blood urea nitrogen (BUN), and Glomerular Filtration Rate (GFR) up to 72 hours after surgery with preoperative ones. Also, the stage of kidney dysfunction was assessed according to the AKIN classification. The statistical analysis of the data was processed by SPSS 24 program. Results Overall, we reviewed 506 patients chart [260 (51.4%) in albumin and 246 (48.6%) in non-albumin group]. In both groups, serum Cr, BUN, and GFR increased in 72 hours postoperatively compared with preoperative levels. This increase was greater in the non-albumin group than in the albumin group. However, the difference was not statistically significant between the two groups (p > 0.05). None of the patients developed renal failure or required dialysis. Conclusion We concluded that the use of albumin in prime solution did not have a statistically significant effect on postoperative renal dysfunction after CABG.
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Affiliation(s)
- Saeed Khademi
- Department of Anesthesiology, Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Friba Heirany
- Department of Anesthesiology, Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Jouybar
- Department of Anesthesiology, Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Laleh Dehghanpisheh
- Department of Anesthesiology, Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohmmad Ghazinoor
- Department of Surgery, Section of Cardiac Surgery, Shiraz University of Medical Sciences, Iran
| | - Leila Shojaei Mehr
- Department of Anesthesiology, Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Jeng LB, Chan WL, Teng CF. Prognostic Significance of Serum Albumin Level and Albumin-Based Mono- and Combination Biomarkers in Patients with Hepatocellular Carcinoma. Cancers (Basel) 2023; 15:cancers15041005. [PMID: 36831351 PMCID: PMC9953807 DOI: 10.3390/cancers15041005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 01/31/2023] [Accepted: 02/03/2023] [Indexed: 02/08/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the predominant form of primary liver cancer. Although many surgical and nonsurgical therapeutic options have been established for treating HCC, the overall prognosis for HCC patients receiving different treatment modalities remains inadequate, which causes HCC to remain among the most life-threatening human cancers worldwide. Therefore, it is vitally important and urgently needed to develop valuable and independent prognostic biomarkers for the early prediction of poor prognosis in HCC patients, allowing more time for more timely and appropriate treatment to improve the survival of patients. As the most abundant protein in plasma, human serum albumin (ALB) is predominantly expressed by the liver and exhibits a wide variety of essential biological functions. It has been well recognized that serum ALB level is a significant independent biomarker for a broad spectrum of human diseases including cancer. Moreover, ALB has been commonly used as a potent biomaterial and therapeutic agent in clinical settings for the treatment of various human diseases. This review provides a comprehensive summary of the evidence from the up-to-date published literature to underscore the prognostic significance of serum ALB level and various ALB-based mono- and combination biomarkers in the prediction of the prognosis of HCC patients after treatment with different surgical, locoregional, and systemic therapies.
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Affiliation(s)
- Long-Bin Jeng
- Organ Transplantation Center, China Medical University Hospital, Taichung 404, Taiwan
- Department of Surgery, China Medical University Hospital, Taichung 404, Taiwan
- Cell Therapy Center, China Medical University Hospital, Taichung 404, Taiwan
| | - Wen-Ling Chan
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung 413, Taiwan
- Epigenome Research Center, China Medical University Hospital, Taichung 404, Taiwan
| | - Chiao-Fang Teng
- Organ Transplantation Center, China Medical University Hospital, Taichung 404, Taiwan
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung 404, Taiwan
- Program for Cancer Biology and Drug Development, China Medical University, Taichung 404, Taiwan
- Research Center for Cancer Biology, China Medical University, Taichung 404, Taiwan
- Correspondence: ; Tel.: +886-4-2205-2121; Fax: +886-4-2202-9083
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Ullah A, Kwon HT, Lim SI. Albumin: A Multi-talented Clinical and Pharmaceutical Player. BIOTECHNOL BIOPROC E 2022. [DOI: 10.1007/s12257-022-0104-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Choi SU, Rho JH, Choi YJ, Jun SW, Shin YJ, Lee YS, Shin HJ, Lim CH, Shin HW, Kim JH, Lee HW, Lim HJ. Postoperative hypoalbuminemia is an independent predictor of 1-year mortality after surgery for geriatric intertrochanteric femoral fracture: A retrospective cohort study. Medicine (Baltimore) 2021; 100:e28306. [PMID: 34941120 PMCID: PMC8701452 DOI: 10.1097/md.0000000000028306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 11/26/2021] [Indexed: 01/05/2023] Open
Abstract
Preoperative hypoalbuminemia from malnutrition is associated with increased morbidity and mortality after geriatric hip fracture surgery. However, little is known regarding the correlation between postoperative hypoalbuminemia and mortality. This study aimed to evaluate whether postoperative hypoalbuminemia could predict 1-year mortality after intertrochanteric femoral fracture surgery in elderly patients.The medical records of 263 geriatric patients (age ≥65 years) who underwent intertrochanteric femoral fracture surgery between January 2013 and January 2016 in a single hospital were reviewed retrospectively. The patients were allocated to 2 groups based on lowest serum albumin levels within 2 postoperative days (≥3.0 g/dL [group 1, n = 46] and <3.0 g/dL [group 2, n = 217]. Data between the non-survival and survival groups were compared. Multivariable logistic regression analysis was conducted to identify the independent predictor for 1-year mortality.The 1-year mortality rate was 16.3% after intertrochanteric femoral fracture surgery. Multivariable logistic regression analysis revealed that postoperative hypoalbuminemia was significantly associated with 1-year mortality (adjusted odds ratio, 8.03; 95% confidence interval, 1.37-47.09; P = .021). The non-survival group showed a significantly increased incidence of postoperative hypoalbuminemia (95.4% vs 80.0%, P = .015) and intensive care unit admission (11.6% vs 2.7%, P = .020), older age (82.5 ± 5.8 years vs 80.0 ± 7.2 years, P = .032), lower body mass index (20.1 ± 3.2 kg/m2 vs 22.4 ± 3.8 kg/m2, P < .001), and increased amount of transfusion of perioperative red blood cells (1.79 ± 1.47 units vs 1.43 ± 2.08 units, P = .032), compared to the survival group.This study demonstrated that postoperative hypoalbuminemia is a potent predictor of 1-year mortality in geriatric patients undergoing intertrochanteric femoral fracture surgery. Therefore, exogenous albumin administration can be considered to improve postoperative outcomes and reduce the risk of mortality after surgery for geriatric hip fracture.
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Affiliation(s)
- Sung Uk Choi
- Department of Anesthesiology and Pain Medicine, Anam Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Jeong Ho Rho
- Department of Anesthesiology and Pain Medicine, Okcheon St. Mary’ Hospital, Chungcheongbuk-do, Republic of Korea
| | - Yoon Ji Choi
- Department of Anesthesiology and Pain Medicine, Ansan Hospital, College of Medicine, Korea University, Ansan, Republic of Korea
| | - Seung Woo Jun
- Department of Anesthesiology and Pain Medicine, Anam Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Young Jae Shin
- Department of Anesthesiology and Pain Medicine, Anam Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Yoon Sook Lee
- Department of Anesthesiology and Pain Medicine, Ansan Hospital, College of Medicine, Korea University, Ansan, Republic of Korea
| | - Hyeon Ju Shin
- Department of Anesthesiology and Pain Medicine, Anam Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Choon Hak Lim
- Department of Anesthesiology and Pain Medicine, Anam Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Hye Won Shin
- Department of Anesthesiology and Pain Medicine, Anam Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Jae Hwan Kim
- Department of Anesthesiology and Pain Medicine, Ansan Hospital, College of Medicine, Korea University, Ansan, Republic of Korea
| | - Hye Won Lee
- Department of Anesthesiology and Pain Medicine, Anam Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Hye Ja Lim
- Department of Anesthesiology and Pain Medicine, Anam Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
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8
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Aguilera-Garrido A, del Castillo-Santaella T, Yang Y, Galisteo-González F, Gálvez-Ruiz MJ, Molina-Bolívar JA, Holgado-Terriza JA, Cabrerizo-Vílchez MÁ, Maldonado-Valderrama J. Applications of serum albumins in delivery systems: Differences in interfacial behaviour and interacting abilities with polysaccharides. Adv Colloid Interface Sci 2021; 290:102365. [PMID: 33667972 DOI: 10.1016/j.cis.2021.102365] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/13/2021] [Accepted: 01/13/2021] [Indexed: 12/17/2022]
Abstract
One of the major applications of Serum Albumins is their use as delivery systems for lipophilic compounds in biomedicine. Their biomedical application is based on the similarity with Human Serum Albumin (HSA), as a fully biocompatible protein. In general, Bovine Serum Albumin (BSA) is treated as comparable to its human homologue and used as a model protein for fundamental studies since it is available in high amounts and well understood. This protein can act as a carrier for lipophilic compounds or as protective shell in an emulsion-based vehicle. Polysaccharides are generally included in these formulations in order to increase the stability and/or applicability of the carrier. In this review, the main biomedical applications of Albumins as drug delivery systems are first presented. Secondly, the differences between BSA and HSA are highlighted, exploring the similarities and differences between these proteins and their interaction with polysaccharides, both in solution and adsorbed at interfaces. Finally, the use of Albumins as emulsifiers for emulsion-based delivery systems, concretely as Liquid Lipid Nanocapsules (LLNs), is revised and discussed in terms of the differences encountered in the molecular structure and in the interfacial properties. The specific case of Hyaluronic Acid is considered as a promising additive with important applications in biomedicine. The literature works are thoroughly discussed highlighting similarities and differences between BSA and HSA and their interaction with polysaccharides encountered at different structural levels, hence providing routes to control the optimal design of delivery systems.
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Schaller SJ, Fuest K, Ulm B, Schmid S, Bubb C, von Eisenhart-Rothe R, Friess H, Kirchhoff C, Stadlbauer T, Luppa P, Blobner M, Jungwirth B. Substitution of perioperative albumin deficiency disorders (SuperAdd) in adults undergoing vascular, abdominal, trauma, or orthopedic surgery: protocol for a randomized controlled trial. Trials 2020; 21:726. [PMID: 32811539 PMCID: PMC7433099 DOI: 10.1186/s13063-020-04626-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 07/26/2020] [Indexed: 12/29/2022] Open
Abstract
Background Hypalbuminemia is associated with numerous postoperative complications, so a perioperative albumin substitution is often considered. The objective of SuperAdd is to investigate whether substitution of human albumin, aiming to maintain a serum concentration > 30 g/l, can reduce postoperative complications in normovolemic surgical patients in comparison with standard care. Methods/design SuperAdd is a single-center, prospective, randomized, outcome-assessor blinded, patient blinded controlled trial. The primary outcome is the frequency of postoperative complications identified using the Postoperative Morbidity Survey graded ≥ 2 according to the Clavien-Dindo Score. Adult patients at risk to develop hypalbuminemia, i.e., ASA III or IV or high-risk surgery, are recruited after written informed consent was obtained. The albumin concentration is assessed before the induction of anesthesia and every 3 h until admission to the postanesthesia care unit. If albumin concentrations drop below 30 g/l, patients are randomly allocated to the control or the treatment group. The study intervention is a goal-directed human albumin substitution aimed at a concentration > 30 g/l during surgery and postanesthesia care unit stay. The patients in the control group are treated according to standard clinical care. Postoperative visits are to be performed on days 1, 3, 5, 8, and 15, as well as by telephone 6 months after surgery. Discussion SuperAdd is the first clinical trial in a surgical population investigating the effect of a goal-directed albumin substitution aiming at a serum level > 30 g/l. The nonrestrictive selection of patients guarantees that the patients without albumin screening will most likely not develop hypalbuminemia, thus ensuring generalizability of the study results. Trial registration EudraCT 2016-001313-24. Registered on 5 September 2016. Clinical Trials NCT03167645. Registered on 18 October 2016 and has the Universal Trial Number (UTN) U1111-1181-2625.
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Affiliation(s)
- Stefan J Schaller
- Department of Anesthesiology and Intensive Care, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany.,Department of Anesthesiology and Operative Intensive Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117, Berlin, Germany
| | - Kristina Fuest
- Department of Anesthesiology and Intensive Care, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany
| | - Bernhard Ulm
- Department of Anesthesiology and Intensive Care, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany
| | - Sebastian Schmid
- Department of Anesthesiology and Intensive Care, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany.,Department of Anesthesiology, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Catherina Bubb
- Department of Anesthesiology and Intensive Care, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany.,Department of Anesthesiology, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Rüdiger von Eisenhart-Rothe
- Department of Orthopedics, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany
| | - Helmut Friess
- Department of Surgery, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany
| | - Chlodwig Kirchhoff
- Department of Traumatology, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany
| | - Thomas Stadlbauer
- Department of Vascular Surgery, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany
| | - Peter Luppa
- Institute of Clinical Chemistry and Pathobiochemistry, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany
| | - Manfred Blobner
- Department of Anesthesiology and Intensive Care, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany.,Department of Anesthesiology, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Bettina Jungwirth
- Department of Anesthesiology and Intensive Care, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, Munich, Germany. .,Department of Anesthesiology, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
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Anaesthesia for Liver Transplantation: An Update. ACTA ACUST UNITED AC 2020; 6:91-100. [PMID: 32426515 PMCID: PMC7216023 DOI: 10.2478/jccm-2020-0011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 01/30/2020] [Indexed: 02/07/2023]
Abstract
Liver transplantation (LT) is a challenging surgery performed on patients with complex physiology profiles, complicated by multi-system dysfunction. It represents the treatment of choice for end-stage liver disease. The procedure is performed under general anaesthesia, and a successful procedure requires an excellent understanding of the patho-physiology of liver failure and its implications. Despite advances in knowledge and technical skills and innovations in immunosuppression, the anaesthetic management for LT can be complicated and represent a real challenge. Monitoring devices offer crucial information for the successful management of patients. Hemodynamic instability is typical during surgery, requiring sophisticated invasive monitoring. Arterial pulse contour analysis and thermo-dilution techniques (PiCCO), rotational thromboelastometry (RO-TEM), transcranial doppler (TCD), trans-oesophageal echocardiography (TEE) and bispectral index (BIS) have been proven to be reliable monitoring techniques playing a significant role in decision making. Anaesthetic management is specific according to the three critical phases of surgery: pre-anhepatic, anhepatic and neo-hepatic phase. Surgical techniques such as total or partial clamping of the inferior vena cava (IVC), use of venovenous bypass (VVBP) or portocaval shunts have a significant impact on cardiovascular stability. Post reperfusion syndrome (PRS) is a significant event and can lead to arrhythmias and even cardiac arrest.
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Moujaess E, Fakhoury M, Assi T, Elias H, El Karak F, Ghosn M, Kattan J. The Therapeutic use of human albumin in cancer patients’ management. Crit Rev Oncol Hematol 2017; 120:203-209. [DOI: 10.1016/j.critrevonc.2017.11.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/15/2017] [Accepted: 11/13/2017] [Indexed: 02/07/2023] Open
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Lin CW, Lin CC, Lee PH, Lo GH, Hsieh PM, Koh KW, Lee CY, Chen YL, Dai CY, Huang JF, Chuang WL, Chen YS, Yu ML. The autophagy marker LC3 strongly predicts immediate mortality after surgical resection for hepatocellular carcinoma. Oncotarget 2017; 8:91902-91913. [PMID: 29190884 PMCID: PMC5696150 DOI: 10.18632/oncotarget.19763] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 06/30/2017] [Indexed: 12/22/2022] Open
Abstract
The remnant liver's ability to regenerate may affect post-hepatectomy immediate mortality. The promotion of autophagy post-hepatectomy could enhance liver regeneration and reduce mortality. This study aimed to identify predictive factors of immediate mortality after surgical resection for hepatocellular carcinoma (HCC). A total of 535 consecutive HCC patients who had undergone their first surgical resection in Taiwan were enrolled between 2010 and 2014. Clinicopathological data and immediate mortality, defined as all cause-mortality within three months after surgery, were analyzed. The expression of autophagy proteins (LC3, Beclin-1, and p62) in adjacent non-tumor tissues was scored by immunohistochemical staining. Approximately 5% of patients had immediate mortality after surgery. The absence of LC3, hypoalbuminemia (<3.5 g/dl), high alanine aminotransferase, and major liver surgery were significantly associated with immediate mortality in univariate analyses. Multivariate logistic regression demonstrated that absence of LC3 (hazard ratio/95% confidence interval: 40.8/5.14-325) and hypoalbuminemia (2.88/1.11-7.52) were significantly associated with immediate mortality. The 3-month cumulative incidence of mortality was 12.1%, 13.0%, 21.4% and 0.4%, respectively, among patients with absence of LC3 expression, hypoalbuminemia, both, or neither of the two. In conclusion, the absence of LC3 expression in adjacent non-tumor tissues and hypoalbuminemia were strongly predictive of immediate mortality after resection for HCC.
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Affiliation(s)
- Chih-Wen Lin
- Division of Gastroenterology and Hepatology, E-Da Dachang Hospital, I-Shou University, Kaohsiung, Taiwan.,Division of Gastroenterology and Hepatology, Department of Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.,Health Examination Center, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Chih-Che Lin
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Po-Huang Lee
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.,Department of Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Gin-Ho Lo
- Division of Gastroenterology and Hepatology, Department of Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Pei-Min Hsieh
- Department of Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Kah Wee Koh
- Division of Gastroenterology and Hepatology, Department of Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.,Health Examination Center, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Chih-Yuan Lee
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Yao-Li Chen
- Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Chia-Yen Dai
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital and Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jee-Fu Huang
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital and Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wang-Long Chuang
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital and Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yaw-Sen Chen
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.,Department of Surgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Ming-Lung Yu
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis Center, Kaohsiung Medical University Hospital and Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan.,Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan.,Liver Center, Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Rabin J, Meyenburg T, Lowery AV, Rouse M, Gammie JS, Herr D. Restricted Albumin Utilization Is Safe and Cost Effective in a Cardiac Surgery Intensive Care Unit. Ann Thorac Surg 2017; 104:42-48. [DOI: 10.1016/j.athoracsur.2016.10.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 09/02/2016] [Accepted: 10/07/2016] [Indexed: 11/25/2022]
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Rehm M, Hulde N, Kammerer T, Meidert AS, Hofmann-Kiefer K. State of the art in fluid and volume therapy. Anaesthesist 2017; 68:1-14. [DOI: 10.1007/s00101-017-0290-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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15
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Rehm M, Hulde N, Kammerer T, Meidert AS, Hofmann-Kiefer K. [State of the art in fluid and volume therapy : A user-friendly staged concept]. Anaesthesist 2017; 66:153-167. [PMID: 28213648 DOI: 10.1007/s00101-017-0272-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Adequate fluid therapy is highly important for the perioperative outcome of our patients. Both, hypovolemia and hypervolemia can lead to an increase in perioperative complications and can impair the outcome. Therefore, perioperative infusion therapy should be target-oriented. The main target is to maintain the patient's preoperative normovolemia by using a sophisticated, rational infusion strategy.Perioperative fluid losses should be discriminated from volume losses (surgical blood loss or interstitial volume losses containing protein). Fluid losses as urine or perspiratio insensibilis (0.5-1.0 ml/kg/h) should be replaced by balanced crystalloids in a ratio of 1:1. Volume therapy step 1: Blood loss up to a maximum value of 20% of the patient's blood volume should be replaced by balanced crystalloids in a ratio of 4(-5):1. Volume therapy step 2: Higher blood losses should be treated by using iso-oncotic, preferential balanced colloids in a ratio of 1:1. For this purpose hydroxyethyl starch can also be used perioperatively if there is no respective contraindication, such as sepsis, burn injuries, critically ill patients, renal impairment or renal replacement therapy, and severe coagulopathy. Volume therapy step 3: If there is an indication for red cell concentrates or coagulation factors, a differentiated application of blood and blood products should be performed.
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Affiliation(s)
- M Rehm
- Klinik für Anaesthesiologie, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland.
| | - N Hulde
- Klinik für Anaesthesiologie, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland
| | - T Kammerer
- Klinik für Anaesthesiologie, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland
| | - A S Meidert
- Klinik für Anaesthesiologie, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland
| | - K Hofmann-Kiefer
- Klinik für Anaesthesiologie, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland
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16
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de Toledo LAK, Noblat ACB, do Nascimento HF, Noblat LDACB. Economic evaluation of human albumin use in patients with nephrotic syndrome in four Brazilian public hospitals: pharmacoeconomic study. SAO PAULO MED J 2017; 135:92-99. [PMID: 28443947 PMCID: PMC9977339 DOI: 10.1590/1516-3180.2016.0048030516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 05/03/2016] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE: In 2004, the Brazilian National Health Surveillance Agency (Agência Nacional de Vigilância Sanitária, ANVISA) published a resolution establishing guidelines for albumin use. Although the published data do not indicate any definitive conclusions about the benefits of albumin use in patients with nephrotic syndrome (NS), the guidelines recommend this procedure only in cases of edema that is refractory to use of diuretics. The aim here was to analyze albumin use among patients with nephrotic syndrome. DESIGN AND SETTING: Pharmacoeconomic study conducted in four large public referral hospitals for nephrology services in northeastern Brazil. METHOD: Cost-effectiveness and cost-utility economic evaluations were performed on a concurrent cohort of patients with nephrotic syndrome, who were divided into two groups according to compliance or noncompliance with the guidelines. Quality-of-life data were obtained from the SF36 and CHQ-PF50 questionnaires. RESULTS: This study enrolled 109 patients (60% adults and 56% women); 41.3% were using albumin in accordance with the guidelines. The weight, diuresis and fluid balance parameters were more cost-effective for patients who adhered to the guidelines. Regarding days of hospitalization avoided, the incremental ratio showed a daily cost of R$ 55.33, and guideline-compliant patients were hospitalized for five days or fewer. The quality of life improved by 8%, and savings of R$ 3,458.13/QALY (quality-adjusted life year) for the healthcare system were generated through guideline compliance. CONCLUSION: The economic analyses of this study demonstrated that there were greater cost benefits for patients whose treatment followed the guidelines.
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Affiliation(s)
- Leonardo Augusto Kister de Toledo
- MSc. Pharmacist, Hospital Universitário Professor Edgard Santos (HUPES), Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil.
| | - Antônio Carlos Beisl Noblat
- MD, PhD. Nephrologist, Head of Complex Care Management Division, Hospital Universitário Professor Edgard Santos (HUPES), Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil.
| | | | - Lúcia de Araújo Costa Beisl Noblat
- Pharmacyst, PhD. Professor, School of Pharmacy, Universidade Federal da Bahia (UFBA), and Education and Research Manager, Hospital Universitário Professor Edgard Santos (HUPES), Salvador (BA), Brazil.
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Taeger CD, Friedrich O, Drechsler C, Weigand A, Hobe F, Geppert CI, Münch F, Birkholz T, Buchholz R, Horch RE, Präbst K. Hydroxyethyl starch solution for extracorporeal tissue perfusion. Clin Hemorheol Microcirc 2016; 64:91-103. [DOI: 10.3233/ch-162049] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Christian D. Taeger
- Department of Plastic and Hand Surgery, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany (FAU), Erlangen, Germany
| | - Oliver Friedrich
- Institute of Medical Biotechnology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Caroline Drechsler
- Department of Plastic and Hand Surgery, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany (FAU), Erlangen, Germany
| | - Annika Weigand
- Department of Plastic and Hand Surgery, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany (FAU), Erlangen, Germany
| | - Frieder Hobe
- Institute of Bioprocess Engineering, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Carol I. Geppert
- Chair of Pathology and Anatomy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Frank Münch
- Department of Paediatric Cardiac Surgery, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Torsten Birkholz
- Department of Anesthesiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Rainer Buchholz
- Institute of Bioprocess Engineering, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Raymund E. Horch
- Department of Plastic and Hand Surgery, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany (FAU), Erlangen, Germany
| | - Konstantin Präbst
- Institute of Bioprocess Engineering, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
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18
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Johnson PN, Romanelli F, Smith KM, Ranjan D, Butler JS, Clifford TM. Analysis of Morbidity in Liver Transplant Recipients following Human Albumin Supplementation: A Retrospective Pilot Study. Prog Transplant 2016; 16:197-205. [PMID: 17007153 DOI: 10.1177/152692480601600303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives To assess incidence of morbidity (ie, documented infection, acute renal failure, acute graft rejection, acute cardiovascular events, and hospital read-mission rates) 6 months following liver transplantation using linear regression as a function of cumulative albumin dose. Design Retrospective chart review. Setting A 473-bed tertiary care teaching facility with a solid-organ transplantation center. Patients Forty liver transplant recipients examined from January 1 to December 31, 2003. Measurements and Results Data from 40 liver transplant recipients were collected. Mean albumin dose administered was 190.9 ± 162.3 g. No statistical differences were identified in patients receiving less than 140 g (n = 20) or more than 140 g (n = 20) with respect to demographic data other than gender and ethnicity. The mean APACHE III (Acute Physiology and Chronic Health) score was 69.7 ± 24.3. Approximately 70 episodes of morbidity and 23 readmissions were observed. Regardless of the APACHE III score, albumin was associated with increased overall morbidity and cardiovascular complications. Liver transplant recipients receiving more than 140 g had a longer hospital stay (14 vs 8 days, P = .025) and intensive care unit stay (6 vs 3 days, P = .051) than patients receiving 140 g or less. No correlation with risk of acute rejection was seen with albumin or tacrolimus. Conclusion Albumin supplementation among liver transplant recipients was associated with a significant risk for cardiovascular complications and overall number of complications regardless of APACHE III score. Future prospective studies are needed to further define the potential risk for complications in this patient population.
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Affiliation(s)
- Peter N Johnson
- University of Oklahoma, College of Pharmacy, Oklahoma City, USA
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19
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Systemic inflammatory response during cardiac surgery: a pilot study. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2015; 10:125-32. [PMID: 25654585 DOI: 10.1097/imi.0000000000000123] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE There is a growing body of evidence indicating that perioperative fluid management during cardiac surgery influences patient care and outcome. The choice of fluid therapy and the degree of systemic inflammatory response triggered during surgery control the effects of tissue edema formation and end-organ function. As such, "goal-directed" fluid resuscitation protocols that measure colloid osmotic pressure (COP) may promote improvements in patient morbidity and mortality. METHODS Thirty patients scheduled for primary coronary artery bypass grafting were prospectively randomized for perioperative fluid treatment under COP guidance [albumin (ALB), n = 17] or conventional fluid protocols without COP support (control, n = 13). Whole-blood samples were drawn at four different time intervals including (A) anesthesia induction, (B) 10 minutes after the initiation of cardiopulmonary bypass, (C) at the completion of sternal skin approximation, and (D) 3 hours after admission to the cardiac intensive care unit. Interleukin 6 (IL-6) and IL-8 were measured by immunometric, enzyme-linked immunosorbent assays as well as C-reactive protein. Colloid osmotic pressure values were measured using a colloid osmometer. RESULTS As compared with conventional fluid protocols, the patients treated in the intervention (ALB) group received significantly less total perioperative fluid [7893.6 (1874.5) vs 10,754.8 (2403.9), P = 0.001], and this relationship remained after controlling for age, sex, and The Society of Thoracic Surgeons risk score (β = -0.5, t = -3.1, P = 0.005). Colloid osmotic pressure values were significantly higher in the ALB group at time point D after surgery (P = 0.03). There were no significant differences in IL-6, IL-8, and C-reactive protein values between the groups at any of the time blood draw intervals. Perioperative outcomes were evaluated by treatment group. For both groups, the incidence of perioperative morbidity was low and did not differ by treatment group. CONCLUSIONS The use of COP-guided fluid resuscitation was associated with a significant reduction in perioperative fluid demand. However, patients prescribed to COP-guided fluid therapy did not experience a reduction in whole-body inflammation or improved surgical outcome as compared with conventional fluid management techniques.
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Zhu P, Zhang B, Wang R, Mei B, Cheng Q, Chen L, Wei G, Xu DF, Yu J, Xiao H, Zhang BX, Chen XP. Selective Inflow Occlusion Technique Versus Intermittent Pringle Maneuver in Hepatectomy for Large Hepatocellular Carcinoma: A Retrospective Study. Medicine (Baltimore) 2015; 94:e2250. [PMID: 26683942 PMCID: PMC5058914 DOI: 10.1097/md.0000000000002250] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Selective inflow occlusion (SIO) maneuver preserved inflow of nontumorous liver and was supposed to protect liver function. This study aims to evaluate whether SIO maneuver is superior to Pringle maneuver in patients undergoing partial hepatectomy with large hepatocellular carcinomas (HCCs). Between January 2008 and May 2012, 656 patients underwent large HCC resections and were divided into 2 groups: intermittent Pringle maneuver (IP) group (n = 336) and SIO group (n = 320). Operative parameters, postoperative laboratory tests, and morbidity and mortality were analyzed. In comparison to the IP maneuver, the SIO maneuver significantly decreased intraoperative blood loss (473 vs 691 mL, P = 0.001) and transfusion rates (11.3% vs 28.6%, P = 0.006). The rate of major complication between the 2 groups was comparable (22.6% vs 18.8%, P = 0.541). Patients with moderate/severe cirrhosis, total bilirubin > 17 μmol/L, or HBV DNA> = 104 copy/mL in SIO group resulted in lower major complication rates. The SIO maneuver is a safe and effective technique for large HCC resections. In patients with moderate/severe cirrhosis, total bilirubin > 17 μmol/L, or HBV DNA> = 104 copy/mL, the SIO technique is preferentially recommended.
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Affiliation(s)
- Peng Zhu
- From the Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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21
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Fitzgerald DC, Holmes SD, Onge JRS, Ioanou C, Martin LM, Ad N. Systemic Inflammatory Response during Cardiac Surgery: A Pilot Study. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2015. [DOI: 10.1177/155698451501000209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- David C. Fitzgerald
- Division of Cardiothoracic Surgery, Inova Heart and Vascular Institute, Falls Church, VA USA
| | - Sari D. Holmes
- Division of Cardiothoracic Surgery, Inova Heart and Vascular Institute, Falls Church, VA USA
| | - John R. St. Onge
- Division of Cardiothoracic Surgery, Inova Heart and Vascular Institute, Falls Church, VA USA
| | - Chidima Ioanou
- Division of Cardiothoracic Surgery, Inova Heart and Vascular Institute, Falls Church, VA USA
| | - Lisa M. Martin
- Division of Cardiothoracic Surgery, Inova Heart and Vascular Institute, Falls Church, VA USA
| | - Niv Ad
- Division of Cardiothoracic Surgery, Inova Heart and Vascular Institute, Falls Church, VA USA
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Ascenzi P, Fanali G, Fasano M, Pallottini V, Trezza V. Clinical relevance of drug binding to plasma proteins. J Mol Struct 2014. [DOI: 10.1016/j.molstruc.2013.09.053] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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23
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Borges de Santana V, Bertocco de Paiva Haddad L, Morgado Conte T, Cortez Rizzon A, Miranda Barbosa V, Shield W, Andraus W, Augusto Carneiro D’Albuquerque L. MELD Score and Albumin Replacement Are Related to Higher Costs During Management of Patients With Refractory Ascites. Transplant Proc 2014; 46:1760-3. [DOI: 10.1016/j.transproceed.2014.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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24
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Tian CR, Qian L, Shen XZ, Li JJ, Wen JT. Distribution of serum total protein in elderly Chinese. PLoS One 2014; 9:e101242. [PMID: 24967900 PMCID: PMC4072719 DOI: 10.1371/journal.pone.0101242] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 06/04/2014] [Indexed: 11/28/2022] Open
Abstract
The serum total protein levels of the elderly possibly decrease gradually with aging. However, serum total protein levels are not suitable as a uniform reference standard for the elderly at different ages and genders. Thus, we investigated the total serum protein distribution in different gender and age groups of 11,453 elderly individuals aged ≥60 years and without liver or renal disease from Lianyungang, Jiangsu, China. The total protein levels (TPL) of these individuals exhibited normal distribution (Z = 1.206, P = 0.109), whereas the reference range (95% CI) was 54.1 g/L to 82.3 g/L. TPL was higher in females than in males for those aged between 60 and 75 years, whereas no significant difference was observed for those aged between 80 and 95 years. TPL was negatively correlated with age in males (r = −0.1342, P<0.05), females (r = −0.304, P<0.05), and the total group (r = −0.2136, P<0.05). TPL also decreased with aging and showed a faster rate in women than in men. These results indicated that an appropriate range of serum total protein based on age and gender differences should be used for clinical applications.
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Affiliation(s)
- Chang-Rong Tian
- Department of Geriatrics, The Second People's Hospital of Lianyungang, Xinpu, China
| | - Li Qian
- Department of Microbiology Laboratory, The Second People's Hospital of Lianyungang, Xinpu, China
| | - Xiao-Zhu Shen
- Department of Geriatrics, The Second People's Hospital of Lianyungang, Xinpu, China
| | - Jia-Jing Li
- Department of Electronic and Information Engineering Center, The Second People's Hospital of Lianyungang, Xinpu, China
| | - Jiang-Tao Wen
- Department of Clinical Science Experiment Center, The Second People's Hospital of Lianyungang, Xinpu, China
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Cho JE, Shim JK, Song JW, Lee HW, Kim DH, Kwak YL. Effect of 6% hydroxyethyl starch 130/0.4 as a priming solution on coagulation and inflammation following complex heart surgery. Yonsei Med J 2014; 55:625-34. [PMID: 24719128 PMCID: PMC3990094 DOI: 10.3349/ymj.2014.55.3.625] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 09/11/2013] [Accepted: 10/02/2013] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Prolonged duration of cardiopulmonary bypass aggravates the degree of inflammation and coagulopathy. We investigated the influence of 6% hydroxyethyl starch (HES) 130/0.4 on coagulation and inflammation compared with albumin when used for both cardiopulmonary bypass priming and perioperative fluid therapy in patients undergoing complex valvular heart surgery. MATERIALS AND METHODS Fifty four patients were randomly allocated into albumin-HES, albumin-nonHES, and HES-HES groups. The cardiopulmonary bypass circuit was primed with 5% albumin in the albumin-HES and albumin-nonHES group, and with HES in the HES-HES group. As perioperative fluid, only plasmalyte was used in the albumin-nonHES group whereas HES was used up to 20 mL/kg in the albumin-HES and albumin-HES group. Serial assessments of coagulation profiles using the rotational thromboelastometry and inflammatory markers (tissue necrosis factor-α, interleukin-6, and interleukin-8) were performed. RESULTS Patients' characteristics and the duration of cardiopulmonary bypass (albumin-HES; 137±34 min, HES-HES; 136±47 min, albumin-nonHES; 132±39 min) were all similar among the groups. Postoperative coagulation profiles demonstrated sporadic increases in clot formation time and coagulation time, without any differences in the actual amount of perioperative bleeding and transfusion requirements among the groups. Also, inflammatory markers showed significant activation after cardiopulmonary bypass without any differences among the groups. CONCLUSION Even in the presence of prolonged duration of cardiopulmonary bypass, HES seemed to yield similar influence on the ensuing coagulopathy and inflammatory response when used for priming and perioperative fluid therapy following complex valvular heart surgery compared with conventional fluid regimen including albumin and plasmalyte.
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Affiliation(s)
- Jang-Eun Cho
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University, Seoul, Korea
| | - Jae-Kwang Shim
- Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jong-Won Song
- Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hye-Won Lee
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University, Seoul, Korea
| | - Dong-Hwan Kim
- Department of Anesthesiology and Pain Medicine, Anam Hospital, Korea University, Seoul, Korea
| | - Young-Lan Kwak
- Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
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Das UN. Albumin to globulin ratio and/or plasma albumin in predicting long-term mortality. Am J Surg 2014; 208:157-8. [PMID: 24524861 DOI: 10.1016/j.amjsurg.2013.08.055] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 08/20/2013] [Accepted: 08/20/2013] [Indexed: 11/19/2022]
Affiliation(s)
- Undurti N Das
- UND Life Sciences, 2020, S 360th St, # K-202, Federal Way, WA 98003, USA
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Results of a survey on albumin use in clinical practice in intensive care units. Med Intensiva 2013; 38:403-12. [PMID: 24183619 DOI: 10.1016/j.medin.2013.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 08/10/2013] [Accepted: 08/28/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Human albumin solutions are used in a number of disorders, though their indications are not clear in all circumstances. These solutions are costly, and their benefit has not been established in all settings. It is therefore interesting to assess the presence of albumin solutions in the daily clinical practice of critical care professionals. OBJECTIVES To report the standard clinical practices and to describe the variability of albumin solutions use in critically ill patients. DESIGN A survey sent by e-mail to Spanish and South American Intensive Care Units (ICUs) PERIOD Planning and execution during the year 2012. METHODS A questionnaire comprising 35 questions. RESULTS Fifty-seven surveys were analyzed. The use of albumin solutions was sporadic or negligible in critically ill patients (96.5%). The exceptions were patients with liver disease (87.7% of the responders administered albumin to these patients). A high percentage of professionals claimed to know the available scientific evidence on the use of albumin in patients with liver disease (82.5%) and in patients without liver disease (77.2%). Only 5.3% of the responders preferred to rely on their own experience to establish the indications of albumin use. CONCLUSIONS The use of albumin solutions is infrequent in ICUs, except in patients with liver disease. Evidence-based knowledge on albumin use is declared to be extensive in ICUs. As a rule, opinions on the use of albumin solutions are based on the scientific recommendations, especially in patients with liver disease. Professional experience rarely prevails over the published clinical guidelines.
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Acute Normovolemic Hemodilution in the Pig Is Associated with Renal Tissue Edema, Impaired Renal Microvascular Oxygenation, and Functional Loss. Anesthesiology 2013; 119:256-69. [DOI: 10.1097/aln.0b013e31829bd9bc] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Abstract
Background:
The authors investigated the impact of acute normovolemic hemodilution (ANH) on intrarenal oxygenation and its functional short-term consequences in pigs.
Methods:
Renal microvascular oxygenation (µPo2) was measured in cortex, outer and inner medulla via three implanted optical fibers by oxygen-dependent quenching of phosphorescence. Besides systemic hemodynamics, renal function, histopathology, and hypoxia-inducible factor-1α expression were determined. ANH was performed in n = 18 pigs with either colloids (hydroxyethyl starch 6% 130/0.4) or crystalloids (full electrolyte solution), in three steps from a hematocrit of 30% at baseline to a hematocrit of 15% (H3).
Results:
ANH with crystalloids decreased µPo2 in cortex and outer medulla approximately by 65% (P < 0.05) and in inner medulla by 30% (P < 0.05) from baseline to H3. In contrast, µPo2 remained unaltered during ANH with colloids. Furthermore, renal function decreased by approximately 45% from baseline to H3 (P < 0.05) only in the crystalloid group. Three times more volume of crystalloids was administered compared with the colloid group. Alterations in systemic and renal regional hemodynamics, oxygen delivery and oxygen consumption during ANH, gave no obvious explanation for the deterioration of µPo2 in the crystalloid group. However, ANH with crystalloids was associated with the highest formation of renal tissue edema and the highest expression of hypoxia-inducible factor-1α, which was mainly localized in distal convoluted tubules.
Conclusions:
ANH to a hematocrit of 15% statistically significantly impaired µPo2 and renal function in the crystalloid group. Less tissue edema formation and an unimpaired renal µPo2 in the colloid group might account for a preserved renal function.
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Abstract
The purpose of this article is to update the community of veterinarians performing general anesthesia in horses on fluid therapy. The rationale behind intraoperative fluid therapy, fluid dynamics, and various fluid options (crystalloids, hypertonic saline, colloids) is discussed. Additionally, electrolytes (calcium, potassium, and sodium) are included in the discussion in relation to general anesthesia and intraoperative fluid management.
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Abstract
Ascites is the pathologic accumulation of fluid in the peritoneum. It is the most common complication of cirrhosis, with a prevalence of approximately 10%. Over a 10-year period, 50% of patients with previously compensated cirrhosis are expected to develop ascites. As a marker of hepatic decompensation, ascites is associated with a poor prognosis, with only a 56% survival 3 years after onset. In addition, morbidity is increased because of the risk of additional complications, such as spontaneous bacterial peritonitis and hepatorenal syndrome. Understanding the pathophysiology of ascites is essential for its proper management.
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Abstract
Albumin has been widely used in patients with cirrhosis in an attempt to improve circulatory and renal functions. The benefits of albumin infusions in preventing the deterioration in renal function associated with large-volume paracentesis, spontaneous bacterial peritonitis, and established hepatorenal syndrome in conjunction with a vasoconstrictor are well established. While some of these indications are supported by the results of randomized studies, others are based only on clinical experience and have not been proved in prospective studies. The paucity of well-designed trials, the high cost of albumin, the lack of a clear-cut survival benefit, and fear of transmitting unknown infections make the use of albumin controversial. The recent development of the molecular adsorbent recirculating system, an albumin dialysis, is an example of the capacity of albumin to act by mechanisms other than its oncotic effect. Efforts should be made to define the indications for albumin use, the dose required, and predictors of response, so that patients gain the maximum benefit from its administration.
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Affiliation(s)
- June Sung Lee
- Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
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High-Dose Albumin for Neuroprotection in Acute Ischemic Stroke: From Basic Investigations to Multicenter Clinical Trial. Transl Stroke Res 2012. [DOI: 10.1007/978-1-4419-9530-8_34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Human serum albumin: from bench to bedside. Mol Aspects Med 2011; 33:209-90. [PMID: 22230555 DOI: 10.1016/j.mam.2011.12.002] [Citation(s) in RCA: 1195] [Impact Index Per Article: 91.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 12/21/2011] [Indexed: 02/07/2023]
Abstract
Human serum albumin (HSA), the most abundant protein in plasma, is a monomeric multi-domain macromolecule, representing the main determinant of plasma oncotic pressure and the main modulator of fluid distribution between body compartments. HSA displays an extraordinary ligand binding capacity, providing a depot and carrier for many endogenous and exogenous compounds. Indeed, HSA represents the main carrier for fatty acids, affects pharmacokinetics of many drugs, provides the metabolic modification of some ligands, renders potential toxins harmless, accounts for most of the anti-oxidant capacity of human plasma, and displays (pseudo-)enzymatic properties. HSA is a valuable biomarker of many diseases, including cancer, rheumatoid arthritis, ischemia, post-menopausal obesity, severe acute graft-versus-host disease, and diseases that need monitoring of the glycemic control. Moreover, HSA is widely used clinically to treat several diseases, including hypovolemia, shock, burns, surgical blood loss, trauma, hemorrhage, cardiopulmonary bypass, acute respiratory distress syndrome, hemodialysis, acute liver failure, chronic liver disease, nutrition support, resuscitation, and hypoalbuminemia. Recently, biotechnological applications of HSA, including implantable biomaterials, surgical adhesives and sealants, biochromatography, ligand trapping, and fusion proteins, have been reported. Here, genetic, biochemical, biomedical, and biotechnological aspects of HSA are reviewed.
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Kaneko K, Kimata T, Tsuji S, Shimo T, Takahashi M, Tanaka S. Serum albumin level accurately reflects antioxidant potentials in idiopathic nephrotic syndrome. Clin Exp Nephrol 2011; 16:411-4. [PMID: 22203175 DOI: 10.1007/s10157-011-0578-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Accepted: 12/07/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent observation revealed that serum albumin plays an important role in the host defense mechanism as it is one of the important antioxidants. This study was conducted to investigate whether hypoalbuminemia contributes to a decreased biological antioxidant potentials (BAP) in idiopathic nephrotic syndrome (INS). METHODS Fifty three heparinised blood samples were obtained from 8 patients with INS (median 13.5 years). Eighteen samples from 6 patients with Henoch-Schönlein purpura (HSP median 7 years) were served as control. Intravenous human albumin preparation was also applied for comparison. Measurement of BAP in blood and human albumin preparation was determined by a newly developed devise called FRAS4(®). Comparison among groups and relationships between BAP and albumin concentrations or c-reactive protein (CRP) were studied by Kruskal-Wallis test and Spearman rank correlation test, respectively. RESULTS Serum levels of BAP was significantly lower in patients with nephrotic relapse than those in patients with nephrotic remission or HSP. BAP correlated well with serum albumin levels. Positive relationship was also found between concentration of albumin in human preparation and BAP. Weakly positive CRP sera disclosed both hypoalbuminemia and low BAP. CONCLUSION Our results suggest that decreased antioxidant potentials caused by hypoalbuminemia in INS may contribute to an aberrant immunity.
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Affiliation(s)
- Kazunari Kaneko
- Department of Pediatrics, Kansai Medical University, Hirakata, Osaka, Japan.
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Abstract
Hypoalbuminemia is common among critically ill/injured patients and is strongly associated with increased morbidity and mortality in the patients with and without neurological conditions. Normal serum albumin is important as the primary intravascular antioxidant, in transporting a variety of hormones, medications and electrolytes, in providing colloid osmotic pressure during trans-compartmental fluid movement, in enhancing organ and tissue blood flow, and in supporting acid-base balance. Studies of albumin administration during intravascular resuscitation have not addressed potential longer term benefits to sustaining serum albumin concentrations during critical care. Evidence for such benefit is present although additional prospective studies are needed.
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Affiliation(s)
- David J Powner
- Departments of Neurosurgery and Internal Medicine, University of Texas Health Sciences Center at Houston Medical School, 6431 Fannin Street, MSB 7.154, Houston, TX 77030, USA.
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Wendt-Hornickle EL, Snyder LBC, Tang R, Johnson RA. The effects of lactated Ringer's solution (LRS) or LRS and 6% hetastarch on the colloid osmotic pressure, total protein and osmolality in healthy horses under general anesthesia. Vet Anaesth Analg 2011; 38:336-43. [PMID: 21627758 DOI: 10.1111/j.1467-2995.2011.00622.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate changes in colloid osmotic pressure (COP), total protein (TP) and osmolality (OSM) during anesthesia in horses given intravenous lactated Ringer's solution (LRS) or LRS and hetastarch (HES). STUDY DESIGN Prospective, clinical trial. ANIMALS Fourteen horses presented for surgery. Mean age 8.3 ± 1.9 years; mean weight 452 ± 25 kg. METHODS Horses were premedicated with xylazine intravenously (IV); anesthesia was induced with ketamine and diazepam IV, and maintained with sevoflurane. Butorphanol was administered IV with pre-medications or immediately after induction. Xylazine was administered IV for recovery if necessary. LRS was administered IV to all horses with a target rate of 5-10 mL kg(-1) hour(-1). Half of the horses also received 6% HES, 2.5 mL kg(-1) over 1 hour in addition to LRS. Horses that received LRS only were considered the LRS group. Horses that received both LRS and HES were considered the LRS/HES group. Blood was drawn pre- and post-anesthesia, immediately following induction, and every 30 minutes throughout anesthesia. COP, TP and OSM were measured. RESULTS COP and TP significantly decreased at similar rates for both treatment groups from pre-anesthetic values. Pre-anesthetic COP was significantly greater in the LRS group when compared to the LRS/HES group pre-, post- and throughout anesthesia. In the LRS group post-anesthetic OSM was significantly different than the pre-anesthesia value and that for the LRS/HES group. CONCLUSIONS AND CLINICAL RELEVANCE Administration of IV HES (2.5 mL kg(-1), over 1 hour) in combination with LRS does not attenuate the decrease in COP typically seen during anesthesia with crystalloid administration alone. Based on these results, administration of HES at this rate and total volume would not be expected to prevent fluid shifts into the interstitium through its effects on COP.
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Affiliation(s)
- Erin L Wendt-Hornickle
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI 53706, USA.
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Rozec B, Blanloeil Y, Fernandez M, Cinotti R, Videcoq M, Lejus C. Nature du priming de la circulation extracorporelle en chirurgie cardiaque adulte et pédiatrique. Ing Rech Biomed 2010. [DOI: 10.1016/s1959-0318(10)70004-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Affiliation(s)
- Bruce A Runyon
- Liver Service, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
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Turell L, Botti H, Carballal S, Radi R, Alvarez B. Sulfenic acid--a key intermediate in albumin thiol oxidation. J Chromatogr B Analyt Technol Biomed Life Sci 2009; 877:3384-92. [PMID: 19386559 DOI: 10.1016/j.jchromb.2009.03.035] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Revised: 03/18/2009] [Accepted: 03/23/2009] [Indexed: 12/16/2022]
Abstract
The single thiol of human serum albumin (HSA-SH) is the predominant plasma thiol. Both circulating albumin and pharmaceutical preparations are heterogeneous regarding the thiol redox status, as revealed by anion-exchange-hydrophobic interaction chromatography. Sulfenic acid (HSA-SOH) is an intermediate in HSA-SH oxidation processes that was detected through different techniques including mass spectrometry. Recently, quantitative data led to the determination of rate constants. The preferred fate of HSA-SOH is the formation of mixed disulfides. Alternatively, HSA-SOH can be further oxidized to sulfinic and sulfonic acids. Oxidized forms increase under disease conditions, underscoring the importance of HSA-SH as a plasma scavenger of intravascular oxidants. We here provide a critical review of the oxidation of HSA-SH in the context of the intravascular compartment, with emphasis in the methodological approaches of mass spectrometry and chromatography for the analysis of albumin thiol redox states.
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Affiliation(s)
- Lucía Turell
- Laboratorio de Enzimología, Facultad de Ciencias, Universidad de la República, Montevideo, Uruguay
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Is albumin administration in hypoalbuminemic elderly cardiac surgery patients of benefit with regard to inflammation, endothelial activation, and long-term kidney function? Anesth Analg 2008; 107:1496-503. [PMID: 18931204 DOI: 10.1213/ane.0b013e31818370b2] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Because patients with low albumin levels may benefit from human albumin (HA) administration, we studied correction of hypovolemia with HA in hypoalbuminic elderly cardiac surgery patients. METHODS In a prospective, randomized study, 50 patients aged >80 yr undergoing cardiac surgery using cardiopulmonary bypass with a preoperative serum albumin concentration of <3.5 mg/dL, received either 5% HA (n = 25) or hydroxyethyl starch (6% HES 130/0.4) (n = 25). Volume was added to the priming (500 mL) and given until the morning of the second postoperative day to keep pulmonary capillary wedge pressure or central venous pressure between 12 and 14 mm Hg. RESULTS Inflammatory response (interleukins-6, -10), endothelial activation (intercellular adhesion molecule-1), and kidney function (including glutathione transferase-alpha and neutrophil gelatinase-associated lipocalin) were measured after induction of anesthesia, 5 h after surgery, and the first and second postoperative day. A follow-up, approximately 60 days after discharge from the hospital, was done. Two thousand nine hundred eighty +/- 430 mL of HA and 3060 +/- 680 mL of HES 130/0.4 were given. Serum albumin concentration was significantly increased by HA (to 4.5 +/- 0.3 mg/dL). Serum creatinine, glomerular filtration rate, and urinary levels of alpha-glutathione transferase and neutrophil gelatinase-associated lipocalin were not different in the HA-compared to the HES-treated patients. The inflammatory response was similar in both groups, whereas endothelial activation was less in the HES group. None of the patients developed renal failure requiring renal replacement therapy. CONCLUSION Use of HA in hypoalbuminemic cardiac surgery patients aged >80 yr was without benefit with regard to inflammatory response, endothelial activation, and renal function compared to 6% HES 130/0.4.
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Joachim B. Is correction of severe hypoalbuminemia necessary in the critically ill? Chin Med J (Engl) 2008. [DOI: 10.1097/00029330-200811020-00028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Green RS, Hall RI. Con: Starches Are Not Preferable to Albumin During Cardiac Surgery: A Contrary Opinion. J Cardiothorac Vasc Anesth 2008; 22:485-91. [DOI: 10.1053/j.jvca.2008.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Indexed: 11/11/2022]
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Fluid management in burn patients: Results from a European survey—More questions than answers. Burns 2008; 34:328-38. [DOI: 10.1016/j.burns.2007.09.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2007] [Accepted: 09/22/2007] [Indexed: 11/20/2022]
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Abstract
PURPOSE OF REVIEW Fluid (volume) therapy is an integral component in the management of critically ill patients and fluid management may influence outcome. There is much controversy, however, about the type, timing and amount of fluid therapy. Here, we discuss the evidence available to guide such choices. RECENT FINDINGS Fluid therapy is widely endorsed for resuscitation of critically ill patients across a range of conditions. Yet, the approach to fluid therapy is subject to substantial variation in clinical practice. Emerging data show that the choice, timing and amount of fluid therapy may affect clinical outcomes. Synthetic colloids may increase the risk of acute kidney injury. Albumin may benefit hypoalbuminemic patients with sepsis and acute lung injury but may worsen outcome in traumatic brain injury. Early administration of fluid therapy in sepsis may improve survival but may be unnecessary in patients with penetrating trauma. Later fluid therapy in acute lung injury patients will increase the duration of ventilator dependence without achieving better survival. A positive cumulative balance likely contributes to increased morbidity and mortality after major surgery. SUMMARY Emerging evidence shows that choice, timing and amount of fluid therapy affect outcome. Future studies need to focus on these aspects of fluid therapy by means of larger, more rigorous and blinded controlled trials.
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Affiliation(s)
- Sean M Bagshaw
- Division of Critical Care Medicine, University of Alberta Hospital, University of Alberta, Edmonton, Alberta, Canada
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Chalidis B, Kanakaris N, Giannoudis PV. Safety and efficacy of albumin administration in trauma. Expert Opin Drug Saf 2007; 6:407-15. [PMID: 17688384 DOI: 10.1517/14740338.6.4.407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Albumin is one of the oldest known and studied human proteins. It is characterised by diverse physiological and biochemical properties that render it relevant to many aspects of the disordered vascular and cellular functions after trauma. Apart from the ability to maintain the colloid oncotic pressure, human serum albumin has multiple effects, including antioxidant activity and binding affinity for drugs and toxic substances, inhibition of apoptosis and modulation of trauma-induced inflammatory response. According to the current state of knowledge, there are conflicting results regarding the benefits of albumin administration in critically ill patients. Further investigations are warranted to resolve the continued uncertainty about the safety and efficacy of human serum albumin in specific clinical circumstances and selected populations of severely injured patients.
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Affiliation(s)
- Byron Chalidis
- University of Leeds, School of Medicine, Academic Department of Trauma & Orthopaedics, LGI University Hospital, Clarendon Wing, Great George Sreet, Leeds, UK
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Affiliation(s)
- Gregory A Nuttall
- Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
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Vorgias G, Iavazzo C, Mavromatis J, Leontara J, Katsoulis M, Kalinoglou N, Akrivos T. Determination of the necessary total protein substitution requirements in patients with advanced stage ovarian cancer and ascites, undergoing debulking surgery. Correlation with plasma proteins. Ann Surg Oncol 2007; 14:1919-23. [PMID: 17406944 DOI: 10.1245/s10434-007-9404-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2006] [Accepted: 02/23/2007] [Indexed: 01/12/2023]
Abstract
BACKGROUND Ascites is common in patients with advanced ovarian carcinoma (AOC). Its drainage during surgery affects plasma proteins. We sought to correlate the volume of ascites with the oncological parameters of the disease, calculate its drainage effect on plasma proteins, and determine the necessary substitution requirements and a clinical way of achieving that. PATIENTS AND METHODS We evaluated 138 patients with AOC and ascites who underwent primary cytoreductive surgery. Intraoperatively found ascites and its postoperative production were evaluated. Its drainage effect on plasma proteins and the substitution requirements were determined using a mathematic formula. Human albumin(HA) and fresh frozen plasma (FFP) were used to cover these requirements. RESULTS The intraoperative ascites was found to correlate only with the stage of the disease, while its postoperative production correlated with the residual disease. Optimally debulked patients had a mean ascites production of 128 mL on postoperative day 1 compared with 668 mL of the suboptimally debulked. This production required 3 and 5-7 days, respectively, to drop <50 mL. Plasma proteins fell on their minimum level (88.9 versus 80.8%) on the second postoperative day. The protein deficit was calculated to be 379 and 691 g/day, respectively. This deficit was substituted by administering 2 HA and 2 FFP for 3-6 days. CONCLUSIONS Ascites drainage affects the postoperative homeostasis of plasma proteins. A mean acute drop of 12-20% is monitored on postoperative day 2. This deficit can be managed with HA and FFP for a minimum of 3 days.
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Affiliation(s)
- George Vorgias
- Department of Gynecology, Metaxa Memorial Cancer Hospital, Piraeus, Greece.
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Boldt J, Schölhorn T, Mayer J, Piper S, Suttner S. The value of an albumin-based intravascular volume replacement strategy in elderly patients undergoing major abdominal surgery. Anesth Analg 2006; 103:191-9, table of contents. [PMID: 16790652 DOI: 10.1213/01.ane.0000221179.07006.06] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The value of human albumin (HA) for treating hypovolemia is controversial. Less expensive alternatives such as hydroxyethyl starch (HES) are sometimes refused because of unwanted side effects. We prospectively randomized 50 patients older than 70 years old undergoing major abdominal surgery to receive either 5% HA (n = 25) or a third generation HES preparation (6% HES 130/0.4; n = 25) when mean arterial blood pressure was <60 mm Hg and central venous pressure was <10 mm Hg. Hemodynamics, inflammation (interleukin-6), endothelial activation-integrity (adhesion molecules), coagulation (thrombelastography), and renal function (including kidney-specific proteins) were monitored after the induction of anesthesia, after surgery, 5 h in the intensive care unit, and on the first postoperative day. HA patients received 3960 +/- 590 mL of HA and 5070 +/- 1030 mL of Ringer's lactate solution, and HES patients received 3500 +/- 530 mL of HES and 4550 +/- 880 mL of Ringer's lactate solution. Total protein remained normal only in the HA-treated patients. No significant differences (P > 0.1) between the groups were seen with regard to hemodynamics, coagulation, and kidney function. Plasma levels of interleukin-6 and soluble adhesion molecules were significantly (P < 0.05) higher in the HA- than in the HES-treated patients. We conclude that HA in elderly patients undergoing major abdominal surgery can easily be replaced by a modern HES preparation. Because of the decreased inflammatory response and endothelial activation-injury, HES 130/0.4 seems to be the more appropriate fluid strategy for these patients.
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Affiliation(s)
- Joachim Boldt
- Clinic of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Bremserstr 79, D-67063 Ludwigshafen, Germany.
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