[Indications for the use of human albumin in anesthesia and intensive care medicine].

The plasmatic albumin concentration (3.5-4.5 g/dl) represents about 60% of the total plasma protein. Only 25-40% of whole albumin belongs to the intravascular pool, the majority is distributed in the interstitial space especially of the skin. Main physiological effects of plasmatic albumin are the control of the plasmatic volume by preservation of the colloid oncotic pressure (COP) and the plasmatic transport including the binding of drugs. The COP is the main factor for fixation of the intravascular volume and the prevention of interstitial oedema. The acute volume effects of albumin can be totally replaced by synthetic colloids like hydroxyethyl starch, gelatine, and dextran, with the exception of volume substitution in neonates. In intensive care medicine, the COP-effects of albumin can almost be replaced by synthetic colloids as well. A positive COP-effect by administration of human or synthetic macromolecules is unlikely in patients with capillary leak. For therapy control, the direct measurement of COP is superior to the calculation derived from albumin or total protein. The global clinical situation of the patient and the course of haematocrit should be respected as well. For prevention of interstitial pulmonary oedema, a COP of 15-20 mmHg should be achieved. Up to now, no clinical study verified a positive effect of albumin substitution regarding outcome or incidence of complications in intensive-care patients. Thus, an albumin therapy to maintain a COP of 15-20 mmHg in intensive-care patients is only recommended if a capillary leak is unlikely and the dose limits of synthetic colloids are attained.(ABSTRACT TRUNCATED AT 250 WORDS)