TY - JOUR
T1 - Differential effects of isotonic and hypotonic 4% albumin solution on intracranial pressure and renal perfusion and function
AU - Iguchi, Naoya
AU - Kosaka, Junko
AU - Bertolini, Joseph
AU - May, Clive N.
AU - Lankadeva, Yugeesh R.
AU - Bellomo, Rinaldo
N1 - Funding Information:
We received funding from the Victorian Government through the Operational Infrastructure Scheme, and from CSL Behring (Australia). Yugeesh Lankadeva was supported by a Postdoctoral Fellowship from the National Heart Foundation of Australia and Joseph Bertolini is employed by CSL. None of the other authors had any competing financial interests relevant to this study.
Publisher Copyright:
© 2018, Australasian Medical Publishing co. All rights reserved.
PY - 2018/3/1
Y1 - 2018/3/1
N2 - Objectives: Albumin is used to resuscitate trauma patients but may increase intracranial pressure (ICP). Its effects on renal blood flow and function are unknown. Our aim was to examine the effects of hypertonic albumin on ICP and renal function, and if any effects are due to the hypotonicity of the solution containing albumin or to albumin itself. Design, setting and subjects: Cross-over, randomised controlled experimental study of six adult Merino ewes in the animal facility of a research institute. Method: Sheep were implanted with flow probes around the pulmonary and renal arteries and an ICP monitoring catheter in a lateral cerebral ventricle. Conscious sheep received normal saline, commercially available hypotonic 4% albumin solution (4% Albumex [278 mOsm/kg]) or a novel isotonic 4% albumin solution (288 mOsm/kg), with at least 48 hours between each intervention. Results: Commercial hypotonic albumin solution increased ICP (by 8.5 mmHg [SEM, 2.1 mmHg]; P < 0.01), but neither isotonic albumin solution nor saline significantly changed ICP. The increase in ICP with hypotonic albumin solution was associated with an increase in central venous pressure (CVP) (by 5.4 mmHg [SEM, 0.6 mmHg]; P < 0.001), but no significant changes in cardiac output or stroke volume. None of the infusions changed renal blood flow, plasma creatinine level, creatinine clearance or plasma or urinary electrolyte levels. Conclusion: Compared with saline or isotonic albumin solution, hypotonic albumin solution increased ICP and CVP, but did not alter arterial pressure, cardiac output renal blood flow or renal function. Our findings support the view that the tonicity of the albumin solution, rather than the albumin itself, is responsible for increasing ICP.
AB - Objectives: Albumin is used to resuscitate trauma patients but may increase intracranial pressure (ICP). Its effects on renal blood flow and function are unknown. Our aim was to examine the effects of hypertonic albumin on ICP and renal function, and if any effects are due to the hypotonicity of the solution containing albumin or to albumin itself. Design, setting and subjects: Cross-over, randomised controlled experimental study of six adult Merino ewes in the animal facility of a research institute. Method: Sheep were implanted with flow probes around the pulmonary and renal arteries and an ICP monitoring catheter in a lateral cerebral ventricle. Conscious sheep received normal saline, commercially available hypotonic 4% albumin solution (4% Albumex [278 mOsm/kg]) or a novel isotonic 4% albumin solution (288 mOsm/kg), with at least 48 hours between each intervention. Results: Commercial hypotonic albumin solution increased ICP (by 8.5 mmHg [SEM, 2.1 mmHg]; P < 0.01), but neither isotonic albumin solution nor saline significantly changed ICP. The increase in ICP with hypotonic albumin solution was associated with an increase in central venous pressure (CVP) (by 5.4 mmHg [SEM, 0.6 mmHg]; P < 0.001), but no significant changes in cardiac output or stroke volume. None of the infusions changed renal blood flow, plasma creatinine level, creatinine clearance or plasma or urinary electrolyte levels. Conclusion: Compared with saline or isotonic albumin solution, hypotonic albumin solution increased ICP and CVP, but did not alter arterial pressure, cardiac output renal blood flow or renal function. Our findings support the view that the tonicity of the albumin solution, rather than the albumin itself, is responsible for increasing ICP.
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M3 - Article
C2 - 29458321
AN - SCOPUS:85050749455
VL - 20
SP - 48
EP - 53
JO - Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine.
JF - Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine.
SN - 1441-2772
IS - 1
ER -