Fast versus slow infusion of 20% albumin: a randomized controlled cross-over trial in volunteers

Background: We investigated whether plasma volume (PV) expansion of 20% albumin is larger when the fluid is administered rapidly compared with a slow infusion. Methods: In this open-labeled randomized interventional controlled trial, 12 volunteers (mean age, 28 years) received 3 mL/kg of 20% albumin (approximately 225 mL) over 30 min (fast) and 120 min (slow) in a cross-over fashion. Blood hemoglobin and plasma albumin were measured on 15 occasions during 6 h to estimate the PV expansion and the capillary leakage of albumin and fluid. Results: The largest PV expansion was 16.1%+/- 6.5% (mean +/- SD) for fast infusion and 12.8%+/- 4.0% for slow infusion (p = 0.52).The median area under the curve for the PV expansion was 69% larger for the fast infusion during the first 2 h (p = 0.034), but was then similar for both infusions. The half-life of the PV expansion did not differ significantly (median, 5.6 h versus 5.4 h, p = 0.345), whereas the intravascular half-life of the excess albumin was 8.0 h for fast infusion and 6.3 h for slow infusion (p = 0.028). The measured urine output was almost three times larger than the infused volume. The plasma concentration of atrial natriuretic peptide (MR-proANP) accelerated the capillary leakage of albumin and the urine flow. Conclusions: The intravascular persistence of albumin was longer, but the fluid kinetics was the same, when 20% albumin was infused over 30 min compared with 120 min. We found no disadvantages of administering the albumin at the higher rate.

Automated summary

This study investigated the difference in plasma volume expansion when administering 20% albumin rapidly compared to slowly. The results showed that the rapid infusion led to a larger plasma volume expansion in the first two hours, but both infusion rates had similar effects afterwards. The intravascular persistence of albumin was longer with rapid infusion, and urine output was three times larger than the infused volume. Atrial natriuretic peptide accelerated albumin leakage and urine flow.