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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.
      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.
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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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