Introduction: Available literature suggests albumin resuscitation in septic shock (SS) may reduce vasopressor requirements and cumulative fluid balance, but albumin timing varies. The purpose of this study was to assess optimal timing of albumin within 72 hours of initial SS crystalloid resuscitation. Methods: This retrospective study included SS patients that received guideline-recommended 30 mL/kg of crystalloid resuscitation. The primary objective was to assess the impact of albumin timing on vasopressor alive-and-free days. Secondary endpoints included vasopressor-free days, time to shock resolution, shock recurrence, need for new renal replacement therapy, ICU length of stay, hospital length of stay, and 28-day mortality. Results: Of patients included, 59 received albumin within 72 hours after initial crystalloid resuscitation, while 27 patients did not. Patients received a median of 31.9 mL/kg of initial crystalloid resuscitation that consisted mostly of lactated ringers (54.7%). For patients that received albumin, the median initial dose was 25 g at a concentration of 5% (79.7%). When albumin and no albumin groups were compared, results found no difference in vasopressor alive-and-free days, time to shock resolution, ICU and hospital length of stay (LOS), and 28-day mortality. However, there were significant differences in shock recurrence (13.6% vs 44.4%) and new renal replacement therapy (10.2% vs 0.0%). When albumin is given for SS, optimal timing was found to be 8.75 to 72 hours after initial crystalloid resuscitation for a perceived 6.92 day improvement in vasopressor alive-and-free days compared to those outside the perceived optimal timing. Conclusions: Patients that received albumin within 72 hours of initial SS crystalloid resuscitation had similar vasopressor alive-and-free days with reduced shock recurrence when compared to patients that did not receive albumin. Findings suggest optimal timing for albumin may be 8.75 to 72 hours after crystalloid resuscitation warranting further investigation.
Maier et al. (Sun,) studied this question.