Multicenter retrospective investigation and analysis of the rationality of the application of human albumin in cardiac surgery during the perioperative period

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Author: PAN Wenfei ¹ YU Huan ¹ DANG Dasheng ² CHEN Lijuan ³ LI Te ⁴ SHI Tianlu ⁵ HUANG Banghua ⁶ LI Boxia ⁷ GONG Xiaoxue ⁸  WANG Ying ¹

Affiliation: 1. Department of Pharmacy, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing 100037, China 2. Department of Pharmacy, the Northern Theater Command General Hospital of Chinese PLA, Shenyang 110016, China 3. Department of Pharmacy, Tianjin Chest Hospital, Tianjin 300050, China 4. Department of Pharmacy, Fuwai Yunnan Cardiovascular Hospital, Kunming 650102, China 5. Department of Pharmacy, The First Affiliated Hospital of USTC (Anhui Provincial Hostipal), Hefei 230001, China 6. Department of Pharmacy, The First People's Hospital of Yunnan Province, Kunming 650032, China 7. Department of Pharmacy, The First Hospital of Lanzhou University, Lanzhou 730000, China 8. Institute of Clinical Pharmacy and Pharmacology, Jining First People’s Hospital, Jining 272000, Shandong Province, China

Keywords: Human serum albumin Clinical application Retrospective study Rational drug use

DOI: 10.12173/j.issn.1005-0698.202305040

Reference: PAN Wenfei, YU Huan, DANG Dasheng, CHEN Lijuan, LI Te, SHI Tianlu, HUANG Banghua, LI Boxia, GONG Xiaoxue, WANG Ying.PAN Wenfei, YU Huan, DANG Dasheng, CHEN Lijuan, LI Te, SHI Tianlu, HUANG Banghua, LI Boxia, GONG Xiaoxue, WANG YingMulticenter retrospective investigation and analysis of the rationality of the application of human albumin in cardiac surgery during the perioperative period[J].Yaowu Liuxingbingxue Zazhi,2024, 33(2):176-183.DOI:10.12173/j.issn.1005-0698.202305040.[Article in Chinese]  Copied

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Abstract

Objective To investigate the clinical application of perioperative human serum albumin (HSA) in cardiac surgery in multiple regions in China, and to evaluate the rationality of its clinical application in conjunction with the clinical guidelines, in order to provide a reference for promoting the rational application of HSA.

Methods The medical records of patients who underwent cardiac surgery from April to June 2019 in eight hospitals across the country were retrospectively collected. The statistical information on patients’ general information, the dosage, course of treatment, and cost of HSA, and the serum albumin level before and after medication was analyzed to evaluate the use of HSA. Relevant evaluation criteria were established, and the rationality of its medication was evaluated.

Results Data from a total of 449 patients were included for analysis, the appropriate rate of medication was 81.1%. The course of medication was mostly >2-5 days and the total amount of HSA was mostly 50-99 g. The main purpose of medicaiton were improving colloid osmotic pressure, reducing exudation to improve interstitial edema, postoperative volume expansion.

Conclusion Clinical attention should be paid to ensure the rational application of HSA in cardiac surgery during the perioperative period and prevent the abuse of blood products.

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1.Zausig YA, Chappell D, Becker BF, et al. The impact of crystalloidal and colloidal infusion preparations on coronary vascular integrity, interstitial oedema and cardiac performance in isolated hearts[J]. Critical Care, 2013, 17(5): R203-212. DOI: 10.1186/cc12898.

2.Moret E, Jacob MW, Ranucci M, et al. Albumin-beyond fluid replacement in cardiopulmonary bypass surgery: why, how, and when?[J]. Semin Cardiothorac Vasc Anesth, 2014, 18(3): 252-259. DOI: 10.1177/1089253214535667.

3.Bignami E, Guarnieri M, Gemma M. Fluid management in cardiac surgery patients: pitfalls, challenges and solutions[J]. Minerva Anestesiologica, 2017, 83(6): 638-651. DOI: 10.23736/S0375-9393.17.11512-9.

4.Cochrane Injuries Group Albumin Reviewers. Human albumin administration in critically ill patients: systematic review of randomised controlled trials[J]. BMJ, 1998, 317(7153): 235-240. DOI: 10.1136/bmj.317.7153.235.

5.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[J]. Arch Intern Med, 1995, 155(4): 373-379. DOI: 10.1001/archinte.155.4.373.

6.Liumbruno GM, Bennardello F, Lattanzio A, et al. Italian Society of Transfusion Medicine and Immunohaematology (SIMTI). Recommendations for the use of albumin and immunoglobulins[J]. Blood Transfus, 2009, 7(3): 216-234. DOI: 10.2450/2009.0094-09.

7.周虹, 王华光, 刘丽宏. 468例人血白蛋白临床应用调查与分析[J]. 中国药物应用与监测, 2014, 11(5): 311-315. [Zhou H, Wang HG, Liu LH. Analysis of the clinical application of human serum albumin in 468 patients[J]. Chinese Journal of Drug Application and Monitoring, 2014, 11(5): 311-315.] DOI: CNKI:SUN:YWYY. 0.2014-05-020.

8.程娟, 吴华, 吴国翠,等. 基于循证医学建立我院人血白蛋白临床使用评价的标准[J].中国药房, 2017, 28(2): 257-261. [Cheng J, Wu H, Wu GC. Establishment of evaluation standards for clinical use of human serum albumin in our hospital based on evidence-based medicine[J]. China Pharmacy, 2017, 28(2): 257-261.] DOI: 10.6039/j.issn.1001-0408.2017.02.32.

9.Yu YT, Liu J, Hu B, et al. Expert consensus on the use of human serum albumin in critically ill patients[J]. Chin Med J (Engl), 2021, 134(14): 1639-1654. DOI: 10.1097/CM9. 0000000000001661.

10.Aya HD, Cecconi M, Hamilton M, et al. Goal-directed therapy in cardiac surgery: a systematic review and meta-analysis[J]. Br J Anaesth, 2013, 110: 510-517. DOI: 10.1093/bja/aet020.

11.Johnston LE, Thiele RH, Hawkins RB, et al. Goal-directed resuscitation following cardiac surgery reduces acute kidney injury: a quality initiative pre-post analysis[J]. J Thorac Cardiovasc Surg, 2020, 159: 1868-1877. e1. DOI: 10.1016/j.jtcvs.2019.03.135.

12.Chinese Association of Cardiovascular Surgeons, Chinese Society of Thoracic and Cardiovascular Surgery, Chinese Society of Cardiothoracic and Vascular Anesthesiology. Expert consensus on the use of human serum albumin in adult cardiac surgery[J]. Chin Med J (Engl), 2023, 136(10): 1135-1143. DOI: 10.1097/CM9.0000000000002709.

13.Karas PL, Goh SL, Dhital K. Is low serum albumin associated with postoperative complications in patients undergoing cardiac surgery?[J]. Interact Cardiovasc Thorac Surg, 2015, 21(6): 777-786. DOI: 10.1093/icvts/ivv247.

14.Kingeter AJ, Raghunathan K, Munson SH, et al. Association between albumin administration and survival in cardiac surgery: a retrospective cohort study[J].Can J Anaesth, 2018, 65(11):1218-1227. DOI: 10.1007/s12630-018-1181-4.

15.Jiang Y, Shaw AD. Albumin supplementation as a therapeutic strategy in cardiac surgery: useful tool or expensive hobby?[J]. Anesthesiology, 2016, 124(5): 983-985. DOI: 10.1097/ALN.0000000000001052.

16.欧阳生珀, 童荣生. 人血白蛋白的合理应用概述[J].中国医院药学杂志, 2021, 41(4): 425-429. [Ouyang SP, Tong RS. Rational usage of human albumin[J].Chinese Journal of Hospital Pharmacy, 2021, 41(4): 425-429.] DOI: 10.13286/j.1001-5213.2021.04.18.

17.韩小年, 马莉. 药学服务对人血白蛋白合理应用的干预效果评价[J]. 临床药物治疗杂志, 2016, 14(1): 43-46. [Han XN, Ma L. Effects of pharmaceutical intervention on rational clinical use of human serum albumin[J]. Clinical Medication Journal, 2016, 14(1): 43-46.] DOI: 10.3969/j.issn.1672-3384.2016.01.009.

18.谢希晖, 杜柏荣, 李娟, 等. 药师干预审批制度的建立对医院人血白蛋白合理使用的影响[J]. 中国药事, 2016, 30(3): 228-233. [Xie XH, Du BR, Li J, et al. Influence of pharmacists' intervention of approval system on the rational use of human albumins in the hospital[J].Chinese Pharmaceutical Affairs, 2016, 30(3): 228-233.] DOI: 10.16153/j.1002-7777.2016.03.005.

19.Buckley MS, Knutson KD, Agarwal SK, et al. Clinical pharmacist-led impact on inappropriate albumin use and costs in the critically ill[J]. Ann Pharmacother, 2020, 54(2): 105-112. DOI: 10.1177/1060028019877471.

20.Rabin J, Meyenburg T, Lowery AV, et al. Restricted albumin utilization is safe and cost effective in a cardiac surgery intensive care unit[J]. Ann Thorac Surg, 2017, 104(1): 42-48. DOI: 10.1016/j.athoracsur.2016.10.018.