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Five percent albumin for adult burn shock resuscitation: lack of effect on daily multiple organ dysfunction score

Authors

  • Andrew B. Cooper,

    Corresponding author
    1. From Anesthesiology; Medicine and Anesthesiology; Medicine, Surgery and Biomedical Engineering; and the Interdisciplinary Adult Critical Care Medicine Program, University of Toronto, Toronto, Ontario, Canada; Clinical Product Development, Bayer Biologics, Toronto, Ontario, Canada; St. Michael's Hospital, Toronto, Ontario, Canada; and the Department of Surgery, The University of Texas Health Science Center, San Antonio, Texas.
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  • Stephen M. Cohn,

    1. From Anesthesiology; Medicine and Anesthesiology; Medicine, Surgery and Biomedical Engineering; and the Interdisciplinary Adult Critical Care Medicine Program, University of Toronto, Toronto, Ontario, Canada; Clinical Product Development, Bayer Biologics, Toronto, Ontario, Canada; St. Michael's Hospital, Toronto, Ontario, Canada; and the Department of Surgery, The University of Texas Health Science Center, San Antonio, Texas.
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  • Haibo S. Zhang,

    1. From Anesthesiology; Medicine and Anesthesiology; Medicine, Surgery and Biomedical Engineering; and the Interdisciplinary Adult Critical Care Medicine Program, University of Toronto, Toronto, Ontario, Canada; Clinical Product Development, Bayer Biologics, Toronto, Ontario, Canada; St. Michael's Hospital, Toronto, Ontario, Canada; and the Department of Surgery, The University of Texas Health Science Center, San Antonio, Texas.
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  • Kim Hanna,

    1. From Anesthesiology; Medicine and Anesthesiology; Medicine, Surgery and Biomedical Engineering; and the Interdisciplinary Adult Critical Care Medicine Program, University of Toronto, Toronto, Ontario, Canada; Clinical Product Development, Bayer Biologics, Toronto, Ontario, Canada; St. Michael's Hospital, Toronto, Ontario, Canada; and the Department of Surgery, The University of Texas Health Science Center, San Antonio, Texas.
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  • Thomas E. Stewart,

    1. From Anesthesiology; Medicine and Anesthesiology; Medicine, Surgery and Biomedical Engineering; and the Interdisciplinary Adult Critical Care Medicine Program, University of Toronto, Toronto, Ontario, Canada; Clinical Product Development, Bayer Biologics, Toronto, Ontario, Canada; St. Michael's Hospital, Toronto, Ontario, Canada; and the Department of Surgery, The University of Texas Health Science Center, San Antonio, Texas.
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  • Arthur S. Slutsky,

    1. From Anesthesiology; Medicine and Anesthesiology; Medicine, Surgery and Biomedical Engineering; and the Interdisciplinary Adult Critical Care Medicine Program, University of Toronto, Toronto, Ontario, Canada; Clinical Product Development, Bayer Biologics, Toronto, Ontario, Canada; St. Michael's Hospital, Toronto, Ontario, Canada; and the Department of Surgery, The University of Texas Health Science Center, San Antonio, Texas.
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  • the ALBUR Investigators

    1. From Anesthesiology; Medicine and Anesthesiology; Medicine, Surgery and Biomedical Engineering; and the Interdisciplinary Adult Critical Care Medicine Program, University of Toronto, Toronto, Ontario, Canada; Clinical Product Development, Bayer Biologics, Toronto, Ontario, Canada; St. Michael's Hospital, Toronto, Ontario, Canada; and the Department of Surgery, The University of Texas Health Science Center, San Antonio, Texas.
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  • This study was funded by Bayer Biologics Canada.

Andrew B. Cooper, MD, Department of Critical Care Medicine, Sunnybrook and Women's College Health Science Center, B708-2075 Bayview Avenue, North York, Ontario, Canada M4N 3M5; e-mail: ab.cooper@sw.ca.

Abstract

BACKGROUND:  The effect of 5 percent human albumin on multiple organ dysfunction was investigated during the first 14 days of treatment to determine whether albumin resuscitation might benefit adult burn patients.

STUDY DESIGN AND METHODS:  Multicenter unblinded controlled trial with stratified block (two patients per block) randomization by center and mortality prediction at enrollment (high-risk stratum [predicted mortality, 50%-90%] and low-risk stratum [predicted mortality, <50%]). The primary outcome was the worst multiple organ dysfunction score (MODS), excluding the cardiovascular component, to Day 14. Eligible adults (>15 years) suffering from thermal injury not more than 12 hours before enrollment received fluid resuscitation with Ringer's lactate (n = 23) or 5 percent human albumin plus Ringer's lactate (n = 19) by protocol to achieve recommended (American Burn Association) resuscitation endpoints.

RESULTS:  Forty-two patients were randomly assigned. There were no significant differences (median [95% confidence intervals]) in age (36 [24-45] vs. 31 [25-39] years), burn size (39 [32-53] vs. 32 [26-34] total body surface area percentage), inhalation injury (n = 12/19 vs. n = 11/23), or baseline MODS (3 [1-5] vs. 1.5 [0-2]) between the treatment and control groups. In an intention-to-treat analysis, there was no significant difference between the treatment and control group in the lowest MODS from Day 0 to Day 14 (analysis of covariance, p = 0.73).

CONCLUSION:  Treatment with 5 percent albumin from Day 0 to Day 14 does not decrease the burden of MODS in adult burn patients.

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