CABG --why is IV albumin given?

[SBURNSTEVEN]

When a patient has open heart surgery, they loose an "unobtainable" amount of blood in the OR as per the post op note. The nurse receives this patient right after their procedure and their blood pressure is labile. Why is their blood pressure like this? When the patient was at 170, from going from SBP 70 to 170 back and forth, Albumin was given. I would assume with a SBP of 170 this would be bad, but the blood pressure was not just 170 but up and down. The rationale I heard was because the patient was 'dry'; they lost blood in the OR obviously. Someone help me to understand why/how Albumin would help this patient.

[tcvnurse, BSN, RN]

Fresh hearts of often extremely labile for the first few hours after arrival in the ICU and sometimes longer. Generally if their blood pressure is wildly flipping from high to low the patient probable needs fluids. PROBABLY. Especially in the very early post op period. Get Swan set up, shoot numbers,. That helps determine care. High SVRI indicates vasoconstriction- body trying to keep blood pressure up in a shock-like state. Give a little fluid helps. Our patients usually get about 2-3L of crystalloid -plasmalite mostly. Our docs are now tending to avoid the use of albumin as much as possible --they say it does not improve outcomes and can be correlated with AKI.

Keep in mind that the body is undergoing and intense inflammatory response right after surgery, expect capillary leak syndrome and fluid shifts.

Re: the OP- I have never seen an OR record where they said 'unobtainable EBL'. Usually they have a pretty good idea cause they do the cell saver thing and give it back.