ICN Victoria presents Dr Craig Walker arguing the case AGAINST albumin, in part two of "The Great Albumin Debate - a Battle of Colloidal Proportions".

1. Monash
C ritical Care hildren’s

2. Colloid of the Year
vs
Overused & Overated

11. Pos
m

12. Plasma Interstitial
H22O H2O
Na+
Na+
Na+
Na+
Na+
Na+
K+
Na+
Na+
ATP
Extracellular Fluid Intracellular Fluid

13. Plasma Interstitial
Alb
Na+
Alb
Na+
Na+
Na+
Na+
Na+
Na+
Alb
Alb
Alb
Extracellular Fluid Intracellular Fluid

14. Plasma Interstitial
Extracellular Fluid Intracellular Fluid

15. Plasma Interstitial
Extracellular Fluid Intracellular Fluid

16. A
A
A
A
A
A
A
Plasma Interstitial
Extracellular Fluid Intracellular Fluid

17. Plasma Interstitial
A
A
A
A
A
A
A
Extracellular Fluid Intracellular Fluid

18. Plasma Interstitial
A
A
A
A
A
A
A
Extracellular Fluid Intracellular Fluid

19. Plasma Interstitial
A
A
A
A
A
A
A
Extracellular Fluid Intracellular Fluid

20. Na+
Na+
Na+
Na+
Na+
Na+
Na+
Plasma Interstitial
Extracellular Fluid Intracellular Fluid

21. Plasma Interstitial
Na+
Na+
Na+
Na+
Na+
Na+
Na+
Extracellular Fluid Intracellular Fluid

22. Plasma Interstitial
Na+
Na+
Na+
Na+
Na+
Na+
Na+
Extracellular Fluid Intracellular Fluid

23. ΔF = Kf [( Pvasc − Pi ) − ( πvasc − πi )]

24. ΔF = Kf [( Pvasc − Pi ) − σ( πvasc − πi )]

25. ΔF = Kf [( Pvasc − Pi ) − σ( πvasc − πi )]

26. ΔF = σ( πvasc − πi )

27. Pos
m

28. 280mmol/L 3% Saline

29. 280mmol/L 3% Saline
Δ Osm = 1027-280 = 747mosmol/L
π = 747 × 19.32mmHg

30. 280mmol/L 3% Saline
Δ Osm = 1027-280 = 747mosmol/L
π = 747 × 19.32mmHg

31. N. Saline
N. Saline
Δ Osm = 40 ∕ 67,000 = 0.6mosmol/L
π = 0.6 × 19.32mmHg
+
40gm/l Albumin

32. N. Saline
N. Saline
+
40gm/l Albumin

33. N. Saline N. Saline
+
40gm/l Albumin
+
8gm/l Albumin
π = 8/67,000 X 19.32
= 2.3 mmHg

34. N. Saline N. Saline
+
40gm/l Albumin
+
8gm/l Albumin
2.3 mmHg

35. 2.3 mmHg 11 mmHg
N. Saline N. Saline
+
40gm/l Albumin
+
8gm/l Albumin
σ

36. 2.3 mmHg 11 mmHg
N. Saline N. Saline
+
40gm/l Albumin
+
8gm/l Albumin
σ

37. 2.3 mmHg 11 mmHg
N. Saline N. Saline
+
40gm/l Albumin
+
8gm/l Albumin
σ = 0.8

38. 2.3 mmHg 11 mmHg
N. Saline N. Saline
+
40gm/l Albumin
+
8gm/l Albumin
σ
0.8 × (11 -2.3)
(πvasc - πi)

39. 2.3 mmHg 4.3 mmHg
N. Saline N. Saline
+
15gm/l Albumin
+
8gm/l Albumin
σ
0.8 × (4.3 -2.3)
(πvasc - πi)

40. 2.3 mmHg 4.3 mmHg
N. Saline N. Saline
+
15gm/l Albumin
+
8gm/l Albumin
σ
0.8 × (4.3 -2.3)
(πvasc - πi)

41. 2.3 mmHg 4.3mmHg to 5.8mmHg
N. Saline N. Saline
+
15gm/l to 20gm/l
Albumin
+
8gm/l Albumin
σ
0.8 × (5.8 -2.3)
(πvasc - πi)

42. 2.3 mmHg 4.3mmHg to 5.8mmHg
N. Saline N. Saline
+
15gm/l to 20gm/l
Albumin
+
8gm/l Albumin
Δπ=1.2mmHg

43. 18mmHg
90mmHg
10mmHg
2mmHg
6mmHg

44. ΔF = Kf [( Pvasc − Pi )− σ( πvasc − πi )]

45. • 35 yo woman on IVF
• Admitted with OHSS
• Rx with 5% Albumin
• Increasing breathlessness ?PE
• Transported to ICU

46. •Breathless, sitting upright
•HR 120, BP 130/70, CVP 7
• Pitting oedema to mid sterum
•Serum Albumin 30gm/L

47. ICU O&G
Do Nothing!
Diurese More
5% Albumin

48. • Diuresis +++++
•
+++++++++++++++++++++++++++++
+++++++++++++++++++++++++++++
+++++++++++++++++++++++++
• Oedema & breathlessness resolved
• To ward

49. • Diuresis +++++
•
+++++++++++++++++++++++++++++
+++++++++++++++++++++++++++++
+++++++++++++++++++++++++
• Oedema & breathlessness resolved
• To ward

50. • Diuresis +++++
•
+++++++++++++++++++++++++++++
+++++++++++++++++++++++++++++
+++++++++++++++++++++++++
• Oedema & breathlessness resolved
• To ward

51. Volume Overload
140
117
93
70
47
23
0
Pressure mmHg
Arterioles
Capillaries
Venules
& Veins
Arteries

52. ΔF = Kf [( Pvasc − Pi )− σ( πvasc − πi )]

55. Plasma Interstitial
Extracellular Fluid Intracellular Fluid

56. Plasma Interstitial
Extracellular Fluid Intracellular Fluid

57. Plasma Interstitial
Extracellular Fluid Intracellular Fluid

58. Na+
Na+
Na+
Na+
Na+
Na+
Na+
Plasma Interstitial
Extracellular Fluid Intracellular Fluid

59. Na+
Na+
Na+
Na+
Na+
Na+
Na+
Plasma Interstitial
Extracellular Fluid Intracellular Fluid

60. Plasma Interstitial
Na+
Na+
Na+
Na+
Na+
Na+
Na+
Extracellular Fluid Intracellular Fluid

61. Plasma Interstitial
Na+
Na+
Na+
Na+
Na+
Na+
Na+
Extracellular Fluid Intracellular Fluid

62. Plasma Interstitial
Na+
Na+
Na+
Na+
Na+
Na+
Na+
Pi
Pi
Extracellular Fluid Intracellular Fluid

63. Na+
Na+
Na+
Plasma Interstitial
Na+
Na+
Na+
Na+
Na+
Na+
Na+
Extracellular Fluid Intracellular Fluid

64. Plasma Interstitial
Na+
Na+
Na+
Na+
Na+
Na+
Na+
Na+
Na+
Na+
Extracellular Fluid Intracellular Fluid

65. Plasma Interstitial
Na+
Na+
Na+
Pi
Na+
Na+
Na+
Na+
Na+
Na+
Na+
Extracellular Fluid Intracellular Fluid

66. Plasma
Na+
Na+
Na+
Na+
Na+
Na+
Na+
Na+
Na+
Na+
Extracellular Fluid Intracellular Fluid

67. Na+
Na+
Na+
Na+
Plasma
Na+
Na+
Na+
Na+
Na+
Na+
Na+
Na+
Na+
Na+
Extracellular Fluid Intracellular Fluid

68. Plasma
Na+
Na+
Na+
Na+
Na+
Na+
Na+
Na+
Na+
Na+
Na+
Na+
Na+
Na+
Extracellular Fluid Intracellular Fluid

69. Plasma
Na+
Na+
Na+
Na+
Na+
Na+
Na+
Na+
Na+
Na+
Na+
Na+
Na+
Na+
Extracellular Fluid Intracellular Fluid

76. Something
Something else
O.R.
1.3(0.5, 2.6)
2.1(1.0,3.4)
1.8(0.9,3.3)
2.3(1.9,2.7)
2.1(1.8,2.5)
2.2(1.9, 2.4)
1.0 2.0 3.0
OR
Smith et al 1991
Jones et al 1993
Smith et al 1999
Ng eta 2004
Chu et al 2009

78. “The only colloid
proven to be not
worse than saline!”

79. SAFE Study:
Albumin vs Saline: Volume administered
3000
2000
1000
0
Albumin Saline
Day 1 Day 2 Day 3 Day 4
1.3 1.6 1.3 1.2
1.4 1.6 1.3 1.4
Mean Ratio
Mean + SD