Albumin use in neurosurgical critical care

Study Objective. To examine the use of albumin in patients receiving neurosurgical intensive care. Design. Survey and chart review of albumin use in neurosurgical intensive care units. Setting. University of Kentucky Chandler Medical Center and American Brain Injury Consortium (ABIC). Subjects. Thirty-eight patients who underwent neurosurgery at the University of Kentucky Chandler Medical Center; members of the ABIC. Interventions. Chart review with attention to administration of albumin; mailed survey to 200 ABIC members. Measurements and Main Results. Patients admitted to the neurosurgical intensive care unit at the University of Kentucky Chandler Medical Center over a 6-month interval were evaluated. Albumin, either 5% or 25%, was prescribed for approximately 25% of patients. The indications for use were vasospasm and maintenance of cerebral perfusion pressure. The response rate for the ABIC survey was 39%. Respondents stated that normal saline and albumin were both primary fluid choices for the treatment of vasospasm. Twenty-two percent reported a reduction in albumin prescribing following a formal warning statement issued by the Food and Drug Administration regarding the use of albumin in critically ill patients. Conclusions. Chart review revealed the primary indications for albumin in the neurosurgical intensive care unit, and our survey data demonstrated the lack of consensus among neurosurgeons regarding their fluid of choice for neurosurgery indications. Prospective, randomized investigations comparing colloids to crystalloids in patients receiving neurosurgical intensive care are required to help define the role of albumin in neurosurgery patients.