Albumin Therapy in Critical Care

Strong Evidence-Based Indications

The American Association for the Study of Liver Diseases recommends administering 8 g of albumin per liter of ascites removed when drainage exceeds 5 liters, to prevent post-paracentesis circulatory dysfunction, reducing odds by 61%, hyponatremia by 42%, and mortality by 36% 1, 2, 3
The European Association for the Study of the Liver suggests giving 1.5 g/kg albumin within 6 hours of Spontaneous Bacterial Peritonitis (SBP) diagnosis, followed by 1.0 g/kg on day 3, which reduces kidney impairment and in-hospital mortality 2, 4
The International Club of Ascites recommends an initial dose of 1 g/kg albumin before starting vasoconstrictor therapy for Hepatorenal Syndrome (HRS-AKI), and maintenance of 20-40 g/day albumin during vasoconstrictor treatment, achieving response rates of 64-76% 4, 5

The Society of Critical Care Medicine suggests considering 20% albumin as adjunctive therapy in septic shock only when large volumes of crystalloids are required, although evidence remains insufficient 1, 6
The American College of Chest Physicians recommends against using albumin routinely in critical care, except in specific cases such as large-volume paracentesis, SBP, and HRS-AKI 1, 7

The American College of Chest Physicians advises against using albumin for correction of hypoalbuminemia alone, nutritional supplementation in protein-losing states, routine fluid resuscitation in general ICU patients, and extraperitoneal infections in cirrhosis 1, 2, 3

The European Society of Intensive Care Medicine recommends monitoring for circulatory overload, particularly in hypoproteinemic patients receiving >2 mL/minute infusion rates, and avoiding albumin in patients with cardiac contraindications 4, 7, 8