Association Between 25% Albumin and Fluid Balance in Mechanically Ventilated Children

Background: Albumin is often used to augment diuresis in fluid overloaded patients. The purpose of this study was to determine the association between albumin administration and fluid balance and respiratory outcomes in mechanically ventilated children. Methods: This was a single-center retrospective cohort study of patients 1 month to <18 years old admitted to the pediatric or cardiac ICU between July 1, 2013, and July 1, 2019 who received 25% albumin while mechanically ventilated. The primary outcome was net fluid balance 48 hours before and after albumin administration. Secondary end points included diuretic requirement, oxygenation index (OI), ventilatory index (VI), and lung compliance. A multivariate regression analysis was completed to assess the odds of having negative fluid balance as a function of albumin administration. Results: There were 268 patients screened for study inclusion, of which 110 met inclusion criteria. The median net fluid balances prior to and after albumin were +38.9 mL/kg/48 h (IQR -6.6 to +118) and +6.5 mL/kg/48 h (-49.8 to +57.3), respectively (unadjusted P < .001). There was no difference in OI, VI, or lung compliance. The regression analysis demonstrated significantly higher odds of a negative fluid balance after albumin administration compared with before. Conclusions: Results from this study demonstrated a less positive fluid balance for the 48 h after albumin administration as compared with the 48 h before administration. Despite this reduction in fluid balance after albumin, there were no differences in several respiratory outcomes. Larger multi-center observational or randomized, controlled trials are required to determine if a decrease in positive fluid balance from albumin administration has an impact on respiratory outcomes.