In a recent survey undertaken by Hospital Pharmacy Europe to gauge awareness of senior European hospital pharmacists of the role of albumin in fluid replacement therapy in various hospital settings, the following was found:
Liver
68% of respondents were aware that albumin is recommended as volume replacement therapy, together with large volume paracentesis (LVP) to prevent circulatory dysfunction.
64% of respondents were aware that albumin is recommended as volume replacement therapy in ascites treatment of spontaneous bacterial peritonitis (SBP).
69% of respondents were aware that albumin is recommended as volume replacement therapy in hepatorenal syndrome (HRS).
78% of respondents were aware that no synthetic colloids are recommended in LVP, SBP or HRS due to concerns regarding efficacy and safety.
63% of respondents were aware that, in LVP, SBP and HRS, albumin has been found to decrease morbidity and improve survival.
Sepsis and the critically ill
58% of respondents were aware that the Guidelines for the management of severe sepsis and septic shock recommend albumin as the only colloid to treat hypovolemia when a patient cannot be stabilised with crystalloids,
40% or respondents cited blood pressure as the transfusion trigger in their ICU to use a colloid albumin.
67% of respondents cited hypoalbuminemia as the transfusion trigger in their ICU to use a colloid albumin.
85% of respondents were aware that the FDA and the EMA’s Pharmacovigilance Risk Assessment Committee have advised against the use of hydroxyethyl starch (HES) in critically ill patients on the ICU, including sepsis patients.
Cardiac surgery
32% of respondents indicated that colloids are used in their cardiac surgery department, of whom 73% were aware that the FDA has advised via a black box warning that no type of HES be recommended for use in cardiac surgery due to resulting excessive bleeding compared to albumin.
General
74% of respondents use 20% albumin in their hospitals, compared to 17% who use 5% albumin.
45% of respondents buy albumin via tender, the most common reasons being best price and processing, overall quality of product, previous positive experience with the manufacturer and a centralised national prescribing contract.
37% of respondents do not buy albumin via tender.
43% of respondents state that recent albumin usage has increased: in the ICU (67% of respondents who cited an increase), in cardiac surgery (33% of respondents who cited an increase) and in gastroenterology (38% of respondents who cited an increase).
45% of respondents state that recent albumin usage has remained the same, and 12% state that it has decreased.
22 respondents have requested more information on the use of albumin in liver disease, 24 in sepsis and the ICU and 16 in cardiac surgery.
The views expressed in this survey are not those of the publisher, who cannot be held responsible for any errors or omissions contained therein.
