Albumin Use in Surgical Patients

Evidence-Based Recommendations

The International Collaboration for Transfusion Medicine Guidelines recommends against albumin use in both adult and pediatric cardiovascular surgery 1, 2
In adult patients undergoing cardiovascular surgery, albumin is not suggested for priming the cardiopulmonary bypass circuit or for volume replacement (Conditional Recommendation, Very Low Certainty of Evidence) 1
In pediatric patients undergoing cardiovascular surgery, albumin is not suggested for priming the cardiovascular bypass circuit or for volume replacement (Conditional Recommendation, Very Low Certainty of Evidence) 3
The American College of Chest Physicians recommends against the use of albumin for volume replacement in surgical patients, citing a lack of mortality benefit and potential for increased morbidity 1, 2, 4

A systematic review of 43 randomized trials found no mortality benefit, no difference in kidney failure rates, and no difference in blood loss, ICU length of stay, hospital length of stay, blood component use, or cardiac index with albumin use 1, 2, 4
The largest single trial found increased morbidity with albumin, including higher rates of bleeding, resternotomy, and infection when compared with Ringer's lactate 1, 2, 4

For critically ill adult patients undergoing major surgery, albumin is not suggested for first-line volume replacement or to increase serum albumin levels (Conditional Recommendation, Moderate Certainty of Evidence) 5, 6

Albumin carries significant risks without proven benefit, including fluid overload, hypotension, hemodilution requiring RBC transfusion, anaphylaxis, and peripheral gangrene from dilution of natural anticoagulants 5, 6
Increased bleeding complications have been demonstrated in the largest cardiac surgery trial 1, 2

First-line volume replacement should use crystalloid solutions, such as balanced crystalloids like Ringer's lactate 1, 2
If inadequate response to crystalloids, consider blood products if bleeding, or continue crystalloid resuscitation 5, 6
Do not use albumin to correct low serum albumin levels - postoperative hypoalbuminemia is expected and does not require correction 5, 6

Albumin has strong evidence only in specific liver disease complications, such as large-volume paracentesis in cirrhosis and spontaneous bacterial peritonitis 7

Do not use serum albumin levels as an indication for albumin administration - low albumin is a marker of illness severity, not a treatment target 5, 6, 7
Do not assume albumin provides superior volume expansion - the largest trials show no benefit over crystalloids and potential harm 1, 2
Avoid doses exceeding 87.5 g due to increased risk of fluid overload and worse outcomes 7