The following are the citations I used to create “Albumin in Critically Ill Patients: Evidence, Indications, and the 5% vs 25% Debate,” which is available to watch on YouTube, Apple Podcasts, and Spotify. This work was sponsored by The Vasopressor & Inotrope Handbook, which is available on Amazon (affiliate link) and my Shopify Store (Save 10% with the coupon code “PODCAST”).
Zampieri FG, Bagshaw SM, Semler MW. Fluid Therapy for Critically Ill Adults With Sepsis: A Review. JAMA. 2023 Jun 13;329(22):1967-1980. doi: 10.1001/jama.2023.7560. PMID: 37314271.
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Liu C, Li H, Peng Z, Hu B, Dong Y, Gao X, Frank RD, Kashyap R, Gajic O, Kashani KB. Inclusion of Albumin in the Initial Resuscitation of Adult Patients with Medical Sepsis or Septic Shock: a Propensity Score-Matched Analysis. Shock. 2021 Dec 1;56(6):956-963. doi: 10.1097/SHK.0000000000001810. PMID: 33988539.
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Patel A, Laffan MA, Waheed U, Brett SJ. Randomised trials of human albumin for adults with sepsis: systematic review and meta-analysis with trial sequential analysis of all-cause mortality. BMJ. 2014 Jul 22;349:g4561. doi: 10.1136/bmj.g4561. Erratum in: BMJ. 2014;349:g4850. PMID: 25099709; PMCID: PMC4106199.
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Hanley C, Callum J, Karkouti K, Bartoszko J. Albumin in adult cardiac surgery: a narrative review. Can J Anaesth. 2021 Aug;68(8):1197-1213. English. doi: 10.1007/s12630-021-01991-7. Epub 2021 Apr 21. PMID: 33884561.
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Matejtschuk P, Dash CH, Gascoigne EW. Production of human albumin solution: a continually developing colloid. Br J Anaesth. 2000 Dec;85(6):887-95. doi: 10.1093/bja/85.6.887. Erratum in: Br J Anaesth 2001 Feb;86(2):301. PMID: 11732525.
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Mårtensson J, Bihari S, Bannard-Smith J, Glassford NJ, Lloyd-Donald P, Cioccari L, Luethi N, Tanaka A, Crisman M, Rey de Castro N, Ottochian M, Huang A, Cronhjort M, Bersten AD, Prakash S, Bailey M, Eastwood GM, Bellomo R. Small volume resuscitation with 20% albumin in intensive care: physiological effects : The SWIPE randomised clinical trial. Intensive Care Med. 2018 Nov;44(11):1797-1806. doi: 10.1007/s00134-018-5253-2. Epub 2018 Oct 21. PMID: 30343313.
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https://www.uptodate.com/contents/albumin-solution-drug-information
Caironi P, Gattinoni L. The clinical use of albumin: the point of view of a specialist in intensive care. Blood Transfus. 2009 Oct;7(4):259-67. doi: 10.2450/2009.0002-09. PMID: 20011637; PMCID: PMC2782803.
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Vincent JL, Dubois MJ, Navickis RJ, Wilkes MM. Hypoalbuminemia in acute illness: is there a rationale for intervention? A meta-analysis of cohort studies and controlled trials. Ann Surg. 2003 Mar;237(3):319-34. doi: 10.1097/01.SLA.0000055547.93484.87. PMID: 12616115; PMCID: PMC1514323.
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Woodcock TE, Woodcock TM. Revised Starling equation and the glycocalyx model of transvascular fluid exchange: an improved paradigm for prescribing intravenous fluid therapy. Br J Anaesth. 2012 Mar;108(3):384-94. doi: 10.1093/bja/aer515. Epub 2012 Jan 29. PMID: 22290457.
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Gomez H, Priyanka P, Bataineh A, Keener CM, Clermont G, Kellum JA. Effects of 5% Albumin Plus Saline Versus Saline Alone on Outcomes From Large-Volume Resuscitation in Critically Ill Patients. Crit Care Med. 2021 Jan 1;49(1):79-90. doi: 10.1097/CCM.0000000000004706. PMID: 33165027; PMCID: PMC7746571.
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Squiccimarro E, Stasi A, Lorusso R, Paparella D. Narrative review of the systemic inflammatory reaction to cardiac surgery and cardiopulmonary bypass. Artif Organs. 2022 Apr;46(4):568-577. doi: 10.1111/aor.14171. Epub 2022 Jan 21. PMID: 35061922; PMCID: PMC9303696.
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Shehabi Y, Balachandran M, Al-Bassam W, Bailey M, Bellomo R, Bihari S, Brown A, Brown A, Collins D, Darlison PR, Li MA, Mandarano R, Sarode V, Pakavakis A; ALBICS AKI Study Investigators. Postoperative 20% Albumin Infusion and Acute Kidney Injury in High-Risk Cardiac Surgery Patients: The ALBICS AKI Randomized Clinical Trial. JAMA Surg. 2025 Aug 1;160(8):835-844. doi: 10.1001/jamasurg.2025.1683. PMID: 40498523; PMCID: PMC12159861.
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Zdolsek M, Wuethrich PY, Gunnström M, Zdolsek JH, Hasselgren E, Beilstein CM, Engel D, Hahn RG. Plasma disappearance rate of albumin when infused as a 20% solution. Crit Care. 2022 Apr 11;26(1):104. doi: 10.1186/s13054-022-03979-1. PMID: 35410365; PMCID: PMC9003982.
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Melia D, Post B. Human albumin solutions in intensive care: A review. J Intensive Care Soc. 2021 Aug;22(3):248-254. doi: 10.1177/1751143720961245. Epub 2020 Sep 30. PMID: 34422108; PMCID: PMC8373284.
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Milford EM, Reade MC. Resuscitation Fluid Choices to Preserve the Endothelial Glycocalyx. Crit Care. 2019 Mar 9;23(1):77. doi: 10.1186/s13054-019-2369-x. PMID: 30850020; PMCID: PMC6408751.
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Cusack RAF, Rodríguez A, Cantan B, Garduno A, Connolly E, Zilahi G, Coakley JD, Martin-Loeches I. Microcirculation properties of 20 % albumin in sepsis; a randomised controlled trial. J Crit Care. 2025 Jun;87:155039. doi: 10.1016/j.jcrc.2025.155039. Epub 2025 Feb 27. PMID: 40020556.
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Finfer S, Bellomo R, Boyce N, French J, Myburgh J, Norton R; SAFE Study Investigators. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med. 2004 May 27;350(22):2247-56. doi: 10.1056/NEJMoa040232. PMID: 15163774.
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Caironi P, Tognoni G, Masson S, Fumagalli R, Pesenti A, Romero M, Fanizza C, Caspani L, Faenza S, Grasselli G, Iapichino G, Antonelli M, Parrini V, Fiore G, Latini R, Gattinoni L; ALBIOS Study Investigators. Albumin replacement in patients with severe sepsis or septic shock. N Engl J Med. 2014 Apr 10;370(15):1412-21. doi: 10.1056/NEJMoa1305727. Epub 2014 Mar 18. PMID: 24635772.
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SAFE Study Investigators; Finfer S, McEvoy S, Bellomo R, McArthur C, Myburgh J, Norton R. Impact of albumin compared to saline on organ function and mortality of patients with severe sepsis. Intensive Care Med. 2011 Jan;37(1):86-96. doi: 10.1007/s00134-010-2039-6. Epub 2010 Oct 6. PMID: 20924555.
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Callum J, Skubas NJ, Bathla A, Keshavarz H, Clark EG, Rochwerg B, Fergusson D, Arbous S, Bauer SR, China L, Fung M, Jug R, Neill M, Paine C, Pavenski K, Shah PS, Robinson S, Shan H, Szczepiorkowski ZM, Thevenot T, Wu B, Stanworth S, Shehata N; International Collaboration for Transfusion Medicine Guidelines Intravenous Albumin Guideline Group. Use of Intravenous Albumin: A Guideline From the International Collaboration for Transfusion Medicine Guidelines. Chest. 2024 Aug;166(2):321-338. doi: 10.1016/j.chest.2024.02.049. Epub 2024 Mar 4. PMID: 38447639; PMCID: PMC11317816.
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Xu JY, Chen QH, Xie JF, Pan C, Liu SQ, Huang LW, Yang CS, Liu L, Huang YZ, Guo FM, Yang Y, Qiu HB. Comparison of the effects of albumin and crystalloid on mortality in adult patients with severe sepsis and septic shock: a meta-analysis of randomized clinical trials. Crit Care. 2014 Dec 15;18(6):702. doi: 10.1186/s13054-014-0702-y. PMID: 25499187; PMCID: PMC4284920.
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Bai Z, Lai Y, Han K, Shi L, Guan X, Xu Y. Human albumin for adults with sepsis: An updated systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore). 2024 Dec 27;103(52):e40983. doi: 10.1097/MD.0000000000040983. PMID: 39969316; PMCID: PMC11687998.
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Wigmore GJ, Deane AM, Presneill JJ, Eastwood G, Serpa Neto A, Maiden MJ, Bihari S, Baker RA, Bennetts JS, Ghanpur R, Anstey JR, Raman J, Bellomo R; HAS FLAIR-II investigators. Twenty percent human albumin solution fluid bolus administration therapy in patients after cardiac surgery-II: a multicentre randomised controlled trial. Intensive Care Med. 2024 Jul;50(7):1075-1085. doi: 10.1007/s00134-024-07488-3. Epub 2024 Jul 2. PMID: 38953926; PMCID: PMC11245445.
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Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, Machado FR, Mcintyre L, Ostermann M, Prescott HC, Schorr C, Simpson S, Wiersinga WJ, Alshamsi F, Angus DC, Arabi Y, Azevedo L, Beale R, Beilman G, Belley-Cote E, Burry L, Cecconi M, Centofanti J, Coz Yataco A, De Waele J, Dellinger RP, Doi K, Du B, Estenssoro E, Ferrer R, Gomersall C, Hodgson C, Møller MH, Iwashyna T, Jacob S, Kleinpell R, Klompas M, Koh Y, Kumar A, Kwizera A, Lobo S, Masur H, McGloughlin S, Mehta S, Mehta Y, Mer M, Nunnally M, Oczkowski S, Osborn T, Papathanassoglou E, Perner A, Puskarich M, Roberts J, Schweickert W, Seckel M, Sevransky J, Sprung CL, Welte T, Zimmerman J, Levy M. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021 Nov;47(11):1181-1247. doi: 10.1007/s00134-021-06506-y. Epub 2021 Oct 2. PMID: 34599691; PMCID: PMC8486643.
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Martin GS, Bassett P. Crystalloids vs. colloids for fluid resuscitation in the Intensive Care Unit: A systematic review and meta-analysis. J Crit Care. 2019 Apr;50:144-154. doi: 10.1016/j.jcrc.2018.11.031. Epub 2018 Nov 30. PMID: 30540968.
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Gray AJ, Oatey K, Grahamslaw J, Irvine S, Cafferkey J, Kennel T, Norrie J, Walsh T, Lone N, Horner D, Appelboam A, Hall P, Skipworth RJE, Bell D, Rooney K, Shankar-Hari M, Corfield AR; Albumin, Balanced, and Crystalloid-Sepsis (ABC-Sepsis) Investigators. Albumin Versus Balanced Crystalloid for the Early Resuscitation of Sepsis: An Open Parallel-Group Randomized Feasibility Trial- The ABC-Sepsis Trial. Crit Care Med. 2024 Oct 1;52(10):1520-1532. doi: 10.1097/CCM.0000000000006348. Epub 2024 Jun 24. PMID: 38912884.
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Patanwala AE, Flannery AH, Mehta HB, Hills TE, McArthur CJ, Erstad BL. Comparative Effectiveness of Albumin vs No Albumin on Renal Replacement Therapy and Mortality in Patients With Septic Shock and Renal Impairment. Chest. 2025 Apr;167(4):1090-1098. doi: 10.1016/j.chest.2024.10.012. Epub 2024 Oct 18. PMID: 39426720.
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Myburgh JA, Mythen MG. Resuscitation fluids. N Engl J Med. 2013 Sep 26;369(13):1243-51. doi: 10.1056/NEJMra1208627. PMID: 24066745.
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Raynor, B., Huang, A., Udrea, D. et al. The Role of Albumin in the Resuscitation of Hypotensive Patients. Curr Emerg Hosp Med Rep 11, 89–94 (2023). https://doi.org/10.1007/s40138-023-00268-1
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Pesonen E, Vlasov H, Suojaranta R, Hiippala S, Schramko A, Wilkman E, Eränen T, Arvonen K, Mazanikov M, Salminen US, Meinberg M, Vähäsilta T, Petäjä L, Raivio P, Juvonen T, Pettilä V. Effect of 4% Albumin Solution vs Ringer Acetate on Major Adverse Events in Patients Undergoing Cardiac Surgery With Cardiopulmonary Bypass: A Randomized Clinical Trial. JAMA. 2022 Jul 19;328(3):251-258. doi: 10.1001/jama.2022.10461. PMID: 35852528; PMCID: PMC9297113.
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Shehabi Y, Balachandran M, Al-Bassam W, Bailey M, Bellomo R, Bihari S, Brown A, Brown A, Collins D, Darlison PR, Li MA, Mandarano R, Sarode V, Pakavakis A; ALBICS AKI Study Investigators. Postoperative 20% Albumin Infusion and Acute Kidney Injury in High-Risk Cardiac Surgery Patients: The ALBICS AKI Randomized Clinical Trial. JAMA Surg. 2025 Aug 1;160(8):835-844. doi: 10.1001/jamasurg.2025.1683. PMID: 40498523; PMCID: PMC12159861.
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Wigmore GJ, Anstey JR, St John A, Greaney J, Morales-Codina M, Presneill JJ, Deane AM, MacIsaac CM, Bailey M, Tatoulis J, Bellomo R. 20% Human Albumin Solution Fluid Bolus Administration Therapy in Patients After Cardiac Surgery (the HAS FLAIR Study). J Cardiothorac Vasc Anesth. 2019 Nov;33(11):2920-2927. doi: 10.1053/j.jvca.2019.03.049. Epub 2019 Mar 28. PMID: 31097338.
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Wigmore GJ, Deane AM, Presneill JJ, Eastwood G, Serpa Neto A, Maiden MJ, Bihari S, Baker RA, Bennetts JS, Ghanpur R, Anstey JR, Raman J, Bellomo R; HAS FLAIR-II investigators. Twenty percent human albumin solution fluid bolus administration therapy in patients after cardiac surgery-II: a multicentre randomised controlled trial. Intensive Care Med. 2024 Jul;50(7):1075-1085. doi: 10.1007/s00134-024-07488-3. Epub 2024 Jul 2. PMID: 38953926; PMCID: PMC11245445.
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China L, Freemantle N, Forrest E, Kallis Y, Ryder SD, Wright G, Portal AJ, Becares Salles N, Gilroy DW, O’Brien A; ATTIRE Trial Investigators. A Randomized Trial of Albumin Infusions in Hospitalized Patients with Cirrhosis. N Engl J Med. 2021 Mar 4;384(9):808-817. doi: 10.1056/NEJMoa2022166. PMID: 33657293.
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Lee TH, Kuo G, Chang CH, Huang YT, Yen CL, Lee CC, Fan PC, Chen JJ. Diuretic effect of co-administration of furosemide and albumin in comparison to furosemide therapy alone: An updated systematic review and meta-analysis. PLoS One. 2021 Dec 1;16(12):e0260312. doi: 10.1371/journal.pone.0260312. PMID: 34851962; PMCID: PMC8635380.
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Wang B, Sha W, Gui S, Zou ZY. Efficacy of albumin and loop diuretic Co-administration in reducing mortality among septic patients with hypoalbuminemia. Eur J Pharmacol. 2025 Jul 15;999:177692. doi: 10.1016/j.ejphar.2025.177692. Epub 2025 Apr 30. PMID: 40311834.
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