This document provides guidelines for intravenous albumin administration at Stanford Health Care. It outlines approved indications for albumin use, including large volume paracentesis, plasmapheresis, postoperative volume resuscitation after cardiac surgery, hepatorenal syndrome, spontaneous bacterial peritonitis, major hepatic resection, and postoperative transplants. It also lists indications where albumin may benefit or have unclear benefit with approval. Conditions where albumin is not indicated are also noted. Dosing recommendations are provided for each approved indication.
This is a comprehensive review of the physiology and pathophysiology of iron deficiency anemia and the evolution of its treatment with parenteral iron to the current recommendations. In our practice, in an attempt to minimize allogenic blood transfusions, we optimize preoperatively patients with iron deficiency anemia by means if intravenous iron replacement.
by the renowned pediatrician, Dr Satish Deopujari,
National Chairperson (Ex)
Intensive Care Chapter I A P
Founder Chairman.....
National conference on pediatric critical care
Professor of pediatrics ( Hon ) JNMC:Wardha
Nagpur : INDIA
This is a comprehensive review of the physiology and pathophysiology of iron deficiency anemia and the evolution of its treatment with parenteral iron to the current recommendations. In our practice, in an attempt to minimize allogenic blood transfusions, we optimize preoperatively patients with iron deficiency anemia by means if intravenous iron replacement.
by the renowned pediatrician, Dr Satish Deopujari,
National Chairperson (Ex)
Intensive Care Chapter I A P
Founder Chairman.....
National conference on pediatric critical care
Professor of pediatrics ( Hon ) JNMC:Wardha
Nagpur : INDIA
It includes new definition, pathophysiology, management of sepsis, septic shock and neutropenic sepsis and even newer evolving concepts or types of sepsis.
Renal Replacement Therapy: modes and evidenceMohd Saif Khan
Renal replacement therapy is a supportive care often required in critically ill patients who develop acute renal failure and its complications. Complexity arises when such patients become hemodynamically unstable and pose special challenge to critical care clinicians in ICU to carefully choose dialytic modality to tackle volume and solute overload. This presentation is about short description of modalities of RRT and current evidence regarding initiation, dose and type of modality.
This lecture is based on National guidelines(Sri Lanka) and guidelines by NHS UK. all the materials used to prepare the lecture are trusted and high in quality. also the books referred are internationally recognized. both hyper and hypokalemia management included in the lecture. lecture is free and you can even download. i kept no copy rights. i appreciate your support, comments and suggestions. also i would be grateful if you can make these lectures popular. wishing your success.
A simple description of a less understood topic in Intensive Care Medicine. Aim to make understanding and management easy for the residents and prevention steps for all ICU workers.
A simple presentation on hypokalemia. The most common electrolyte disorder in the Critical Care practice.The presentation is based on a mortality and morbidity case report and discussion. It covers all the basic aspects of understanding the causes of hypokalemia in ICU and its management. Target audience are residents ICU and ER but all health care workers can benefit.
It includes new definition, pathophysiology, management of sepsis, septic shock and neutropenic sepsis and even newer evolving concepts or types of sepsis.
Renal Replacement Therapy: modes and evidenceMohd Saif Khan
Renal replacement therapy is a supportive care often required in critically ill patients who develop acute renal failure and its complications. Complexity arises when such patients become hemodynamically unstable and pose special challenge to critical care clinicians in ICU to carefully choose dialytic modality to tackle volume and solute overload. This presentation is about short description of modalities of RRT and current evidence regarding initiation, dose and type of modality.
This lecture is based on National guidelines(Sri Lanka) and guidelines by NHS UK. all the materials used to prepare the lecture are trusted and high in quality. also the books referred are internationally recognized. both hyper and hypokalemia management included in the lecture. lecture is free and you can even download. i kept no copy rights. i appreciate your support, comments and suggestions. also i would be grateful if you can make these lectures popular. wishing your success.
A simple description of a less understood topic in Intensive Care Medicine. Aim to make understanding and management easy for the residents and prevention steps for all ICU workers.
A simple presentation on hypokalemia. The most common electrolyte disorder in the Critical Care practice.The presentation is based on a mortality and morbidity case report and discussion. It covers all the basic aspects of understanding the causes of hypokalemia in ICU and its management. Target audience are residents ICU and ER but all health care workers can benefit.
Dose Adjustment in Acute Renal Failure and Chronic Kidney Disease. Kevin John
In this presentation, I have tried to explain in brief and precisely about drugs that require renal dose adjustments in Chronic Kidney Disease or Acute Kidney Injury (renal failure).
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
1. Stanford Health Care Created: 03/2017
Pharmacy Department Last Revised:
Guidelines for Intravenous Albumin Administration at Stanford Health Care
Policy:
Pharmacists will evaluate all intravenous albumin orders prior to verification to ensure compliance
with the criteria outlined in this guideline*.
o All orders must include a definitive endpoint of therapy.
o Doses will be rounded to the nearest vial size.
Albumin is NOT approved for Pyxis override.
These guidelines do not apply to intraoperative use.
*NOTE: To request use of albumin that is not in accordance with these guidelines, approval must be
obtained from one of the physician approvers: Drs. Norm Rizk, Ann Weinacker, David Spain, or Charles Hill.
Likely Benefit
(Approved indications)
Large Volume Paracentesis in Patients with Cirrhosis
Defined as >4 L removed with documented cirrhosis (or any amount removed if creatinine is >1.5
gm/dL)
Dosing recommendation:
Albumin 25% 6-8 g per liter of ascitic fluid removed
Plasmapheresis
Dosing recommendation:
Albumin 5% as per plasmapheresis protocol (based on plasma volume and serum fibrinogen level)
May Benefit
(Approved indications)
Postoperative volume resuscitation after Cardiac Surgery
Albumin 5% may only be used if ≥3 L crystalloid has been administered within a given 24-hour period
without an adequate hemodynamic response.
This only includes crystalloids given as a bolus (excludes maintenance fluids, carrier fluids,
etc.)
This excludes fluid given intraoperatively
For diagnosis of Suspected HRS
Defined as acute renal dysfunction (serum creatinine >1.5 mg/dL) in the presence of cirrhosis
Dosing recommendation:
Albumin 25% 1 g/kg/day for 2 days (dose up to a maximum of 100 g per day) See #iii below for the
definition of confirmation of the diagnosis.
Hepatorenal Syndrome (HRS), confirmed
Defined as:
i. Serum creatinine >1.5 mg/dL in the presence of cirrhosis
ii. Absence of shock, ongoing bacterial infection, and/or current treatment with nephrotoxic drugs
iii. Absence of sustained improvement in renal function after discontinuation of diuretics and a trial
of albumin 1 g/kg
iv. Absence of proteinuria (<500 mg/day) or hematuria (<50 red cells per high-power field)
v. Absence of ultrasonographic evidence of obstructive uropathy or parenchymal renal disease
Dosing recommendation:
1. Albumin 25% 25-50 g daily for a total of 72 hours (starting 1-2 days after initial diagnostic trial of
albumin, if applicable), and consult nephrology and hepatology services to determine whether to
continue
2. Should be used in addition to midodrine and octreotide
2. Stanford Health Care Created: 03/2017
Pharmacy Department Last Revised:
May Benefit, cont’d
(Approved indications)
Spontaneous Bacterial Peritonitis (SBP) and cirrhosis
Defined as patients with ascitic fluid PMN counts ≥250 cells/mm3 plus at least one of the following:
1.Serum creatinine >1 mg/dL
2. Blood urea nitrogen >30 mg/dL
3. Total bilirubin >4 mg/dL
Dosing recommendation:
Albumin 25% 1.5 g/kg within 6-hours of detection (day 1) and 1 g/kg on day 3
Major Hepatic Resection (>40% resected)
May be useful after liver resection in patients with serum albumin <2.5 g/dL if crystalloids alone fail to
achieve adequate intravascular volume.
Dosing recommendation:
Albumin 25%, 25 gm/day until albumin is ≥2.5 gm/dL.
If serum albumin remains <2.5, may continue albumin dosing up to 4 days; consult liver
surgeons thereafter for consideration of continued use.
Postoperative Heart Transplant
May be useful to treat anasarca in patients with albumin 3 gm/dL
Dosing recommendation:
1. Albumin 25%, 25 gm IV BID x2 doses (or 12.5 gm IV q6h x4 doses) may be used in
combination with diuretics.
2. Monitor urine output and volume status and assess daily. If successful at achieving diuresis,
may reorder albumin until serum albumin is >3 gm/dL but must be renewed each day after
daily assessment.
Postoperative Lung Transplant
Grade 2 or higher Primary Graft Dysfunction
Dosing recommendation:
Albumin 25%, 25 gm IV BID x2 doses (or 12.5 gm IV q6h x4 doses) for up to 48 hours may be used
in combination with diuretics to improve oxygenation.
Postoperative Liver Transplant
May be useful for the control of ascites and peripheral edema if serum albumin is <2.5 gm/dl
Dosing recommendation:
Albumin 25%, 25 gm/day until albumin is ≥2.5 gm/dL.
If serum albumin remains <2.5, may continue albumin dosing up to 4 days; consult liver
surgeons thereafter for consideration of continued use.
Unclear Benefit
(Approval by nephrology attending required prior to use)
Severe Nephrotic Syndrome (e.g. with anasarca or pulmonary edema)
May be used in demonstrated nephrotic syndrome (>3 g/day of urinary protein excretion [or spot
protein equivalent] + hypercholesterolemia + hypoalbuminemia) and loop diuretic resistance (defined
as an “insufficient response” to an intravenous bolus dose of ≥160 mg furosemide or 4 mg bumetanide
followed by ≥8-hour infusion of ≥20 mg/hr furosemide or ≥0.5 mg/hour bumetanide)
Dosing recommendation:
Albumin 25%, 25 gm in combination with diuretics to effect adequate diuresis. Additional dosing must
be approved by nephrology attending.
3. Stanford Health Care Created: 03/2017
Pharmacy Department Last Revised:
Not Indicated
(Will NOT be approved)
Acute Respiratory Distress Syndrome
Maldistributive shock (eg. Septic Shock)
Traumatic Brain Injury
Major Trauma
Hypoalbuminemia
Kidney Transplant
Hemorrhagic Shock
Abdominal Compartment Syndrome
Cost Comparison of Available Therapies:
Product Description Price per Unit Price Key
1 Liter Normal Saline $
$ = $1 - $9
$$ = $10 - $24
$$$ = $25 - $50
$$$$ = >$50
1 Liter Normosol $
1 Liter Lactated Ringer’s $
1 Liter Plasma-Lyte $$
1 unit of Albumin 5% 250 mL: $$$
500 mL: $$$$
1 unit of Albumin 25% 50 mL: $$$
100 mL: $$$$
Comparison of Therapy Components:
Fluid pH Osmolarity
(mOsm/L)
Sodium
(meq/L)
Chloride
(meq/L)
Potassium
(meq/L)
Calcium
(meq/L)
Other:
Normal
SalineA
5.5 308 154 154 0 0 ---
NormosolA
7.4 294 140 98 5 0 Mg = 3 meq/L
Acetate = 27
meq/L
Gluconate =
23 meq/L
Lactated
Ringer’sA
6.6 275 130 109 4 3 Lactate = 28
meq/L
Plasma-
LyteB
5.5 294 140 98 5 0 Mg = 3 meq/L
Acetate = 27
meq/L
Gluconate =
23 meq/L
Albumin 5%B
7.4 310 145±15 145±15 0 0 ---
Albumin
25%B
7.4 312 145±15 145±15 0 0 ---
(AHospira labeling information, BBaxter labeling information)
References:
General Literature:
1. Vermeulen LC Jr, Ratko TA, Erstad BL, et al. A paradigm for consensus: The University Hospital Consortium
guidelines for the use of albumin, nonprotein colloid, and crystalloid solutions. Arch Intern Med. 1995;155:373-379
2. Martelli A, Strada P, Cagliani I, et al. Guidelines for the clinical use of albumin: comparison of use in two Italian
hospitals and a third hospital without guidelines. Curr Ther Res Clin Exp 2003;64:676-684
4. Stanford Health Care Created: 03/2017
Pharmacy Department Last Revised:
Fluid Resuscitation in Critical Illness
3. Perel P, Roberts I, Ker K. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane
Database Syst Rev 2013;28(2):CD000567
4. Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: International guidelines for management of
severe sepsis and septic shock: 2012. Crit Care Med 2013;41(2):580-637
5. American Thoracic Society Critical Care Assembly. Evidence-based colloid use in the critically ill: American
Thoracic Society consensus statement. Am J Crit Care Med 2004;170:1247-1259
6. Beekly AC. Damage control resuscitation: A sensible approach to the exsanguinating surgical patient. Crit Care
Med 2008;36[Suppl.]:S267-S274
7. Finfer S, Bellomo R, Boyce N, et al. A comparison of albumin and saline for fluid resuscitation in the intensive care
unit. N Engl J Med 2004;350:2247–2256
8. van der Heijden M, Verheij J, van Nieuw Amerongen GP, Groeneveld AB. Crystalloid or colloid fluid loading and
pulmonary permeability, edema, and injury in septic and nonseptic critically ill patients with hypovolemia. Crit Care
Med 2009;37:1275–1281
Renal Transplantation:
9. Abdallah E, El-Shishtawy S, Mosbah O, et al. Comparison between the effects of intraoperative human albumin
and normal saline on early graft function in renal transplantation. Int Urol Nephrol 2014;46(11):2221-6.
Liver Transplantation:
10. Johnson PN, Romanelli F, Smith KM, et al. Analysis of the morbidity in liver transplant recipients following human
albumin supplementation: A retrospective pilot study. Progress in Transplantation 2006;16:197-205
11. Ertmer C, Kampmeier TG, Volkert T, et al. Impact of human albumin infusion on organ function in orthotopic liver
transplantation – a retrospective matched-pair analysis. Clin Transplant 2015;29(1):67-75
Paracentesis/Spontaneous Bacterial Peritonitis/Hepatorenal Syndrome
12. Runyon, B.A. AASLD Practice Guidelines Committee. Management of adult patients with ascites due to cirrhosis:
update 2012. Hepatology. 2013;57:1651–1653
Nephrotic Syndrome:
13. Duffy M, Jain S, Harrell N, et al. Albumin and furosemide combination for management of edema in nephrotic
syndrome: a review of clinical studies. Cells 2015;4(4):622-630
Cardiac Surgery:
14. Frenette AJ, Bouchard J, Bernier P, et al. Albumin administration is associated with acute kidney injury in cardiac
surgery: a propensity score analysis. Crit Care 2014;18(16):602
15. Lee EH, Kim WJ, Chin JH, et al. Effect of exogenous albumin on the incidence of postoperative acute kidney injury
in patients undergoing off-pump coronary artery bypass surgery with a preoperative albumin level of less than 4.0
g/dL. Anesthesiology 2016;124(5):1001-11
Acute Respiratory Distress Syndrome/Acute Lung Injury:
16. Cribbs SK, Martin GS. Fluid balance and colloid osmotic pressure in acute respiratory failure: Optimizing therapy.
Expert Rev Respir Med 2009;3:651-662
17. Martin GS, Mangialardi RJ, Wheeler AP, et al. Albumin and furosemide therapy in hypoproteinemic patients with
acute lung injury. Crit Care Med 2002;30:2175-2182
18. Martin GS, Moss M, Wheeler AP, et al. A randomized, controlled trial of furosemide with or without albumin in
hypoproteinemic patients with acute lung injury. Crit Care Med 2005;33:1681-1687
19. Uhlig C, Silva PL, Deckert S, et al. Albumin versus crystalloid solutions in patients with the acute respiratory
distress syndrome: a systematic review and meta-analysis. Crit Care 2014;18(1):r10
Traumatic Brain Injury:
20. SAFE study investigators. Saline or albumin fluid resuscitation in patients with traumatic brain injury. N Engl J Med
2007;357:874-884
Document Information:
A. Original Authors
a. Ann Weinacker, MD; Hans Ang, PharmD: 03/2017
B. Gatekeeper
a. Pharmacy Department
C. Reviews/Revisions
D. Approvals
a. P&T Committee: 03/2017
This document is intended only for the internal use of Stanford Health Care (SHC). It may not be copied or otherwise used, in whole,
or in part, without the express written consent of SHC. Any external use of this document is on an AS IS basis, and SHC shall not be
responsible for any external use. Direct inquiries to the Director of Pharmacy, Stanford Health Care, 650-723-5970.
Stanford Health Care, Stanford, CA 94305