Re-evaluating albumin use in traumatic brain injury
Abstract Traumatic brain injury (TBI) affects approximately 69 million people annually, with the majority of cases being mild-to-moderate in severity. However, in severe TBI, early management is critical and includes fluid resuscitation to control intracranial pressure (ICP) and optimize cerebral pe...
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| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-08-01
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| Series: | Journal of Intensive Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40560-025-00813-y |
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| Summary: | Abstract Traumatic brain injury (TBI) affects approximately 69 million people annually, with the majority of cases being mild-to-moderate in severity. However, in severe TBI, early management is critical and includes fluid resuscitation to control intracranial pressure (ICP) and optimize cerebral perfusion pressure. The SAFE-TBI study linked hypotonic 4% albumin to higher mortality versus saline (33.2% vs. 20.4%; RR 1.63; P = 0.003), likely due to elevated ICP, prompting guidelines favoring saline. However, these recommendations are based on low-quality evidence and overlook hyperoncotic albumin. Preclinical data confirm that hypotonicity—not albumin—drives ICP elevation. Emerging data suggest that hyperoncotic albumin (20–25%) may reduce ICP and improve outcomes. This letter highlights evidence gaps and advocates re-evaluating albumin use in TBI, especially hyperoncotic formulations. |
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| ISSN: | 2052-0492 |