Plasmanate or 5% Albumin postop

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I was wondering...I had an 87 yr old female pt who ended up with a perforated gastric ulcer that leaked over time into the gut. They took her to surgery, and when she came back to me she was dry. She received large amounts of fluid, but the surgeon refused my suggestion for plasmanate stating that it is a myth that it would help keep the fluid in the intravascular space. He ended up ordering it in the morning because low and behold the patient remained anuric and started to blow up like a balloon. Any comments on this? He is a new surgeon to our hospital, and I was surprised by his opinion on this.

Helix

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explain plasmanate to me please...I work in a CT ICU and we use LR/albumin and Hespan for volume resucitation, but I haven't heard of that.

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Plasmanate is Albumin 5% IMO...it is the best volume expander besides blood products.

There has recently been a big shortage so we have use a lot more LR and Hespan.

The problem with Hespan is that in large amt(everyone has their own opinions of how much is too much) there could be a risk of increased bleeding. Our magic # was 1500cc.

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Oh...BTW...Albumin is a human product. Which does come with it's own potential risks. Jehovah Witness' often will not accept it.

Hespan is synthetic

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HI to all. new here.

As an APN i order a signifcant amount of SPA or hespan on postops who haven't made urine despite fluid challenges. Often I will check an albumin first b/c the last thing i want to do is put someone in failure. However, my intensivist is very big on it in people who are septic and hypotensive. I think Hespan is cheap. Albumin $$ and as mentioned is considered a blood product by J.W..

The surgeons still prefer to give LR and for the most part I don't ever recall them ordering fluid volume expanders. I have no idea the reason why someone would say this was a myth. Maybe he/she just didn't know anything about it. If i were the surgeon i'd be grateful you were watching the I/O so closely. Where I work that oversight makes me crazy.!!

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this is a touchy topic - primarily because some people believe one is better than the other (colloid vs. crystalloid) - so far in most meta-analyses there is no difference in outcome betwee using either colloid (albumin) or crystalloid (LR/saline), and in a few studies they demonstrated a HIGHER mortality rate w/ albumin (up to 5% higher) felt to be due to worsening coagulopathies induced w/ albumin.... There is a very large study in new zealand/australia where they have randomized in a prospective double-blinded study >3600 patients to either saline or albumin, and their results are due early this spring (with early rumors showing that crystalloid is still safer and has better outcomes than albumin).... In fact, I very rarely write for albumin (or SPA - which by the way, is a misnomer - it has the same Sodium content as Normal Saline), and when i do it is because everything else has failed...

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Wouldn't an advantage of giving albumin be that the patient is receiving less fluid volume/less chance of volume overload?

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there are no good studies showing that albumin causes less fluid overload :(

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