Microcirculation properties of 20 % albumin in sepsis; a randomised controlled trial.

Summary

In a single-centre RCT of 100 fluid-responsive septic shock patients, 20% albumin boluses improved microvascular density and activity at 15 and 60 minutes compared with crystalloids, despite worse baseline microcirculation. No differences were observed in fluid balance, vasopressor days, ICU length of stay, or mortality.

Key Findings

• 20% albumin significantly improved microvascular density and activity at 15 and 60 minutes (p<0.005) versus crystalloids.
• Both groups were fluid responsive (mean pulse pressure variability 17%); baseline microcirculation was worse in the albumin group.
• No significant differences in fluid balance, vasopressor days, ICU length of stay, or mortality between groups.

Clinical Implications

For fluid-responsive septic shock, 20% albumin boluses may be considered to acutely improve microcirculation; practice change should await multicentre trials demonstrating patient-centred benefits.

Limitations

• Single-centre study, likely unblinded, and not powered for patient-centred outcomes.
• Baseline microcirculation imbalance; short follow-up for microcirculation endpoints.

Future Directions

Multicentre, outcome-powered RCTs comparing albumin vs crystalloids with microcirculation-guided protocols; subgroup analyses by endothelial glycocalyx injury and albumin levels.