Purpose: Hypoproteinemia in patients with sepsis is associated with positive fluid balance, weight gain, and increased risk of acute lung injury (ALI), which coincides with prolonged mechanical ventilation and increased mortality [AJRCCM 155: A504]. Combined albumin and furosemide therapy in hypoproteinemic ALI patients has been shown to acutely improve oxygenation and increase hemodynamic stability despite [is greater than] 10 kg of weight loss [AJRCCM 159: A376].
Methods: Thirty-seven mechanically ventilated patients with acute lung injury and serum protein levels [is less than or greater than] 5 g/dL were randomized to receive protocolized albumin with furosemide vs. placebo with placebo for 5 days. To elucidate the relative effects of each treatment component, a post hoc multi-variable regression analysis of physiologic outcome variables was undertaken. P-values [is less than] 0.05 were significant.
Results: By 24 hours, combination therapy with albumin and furosemide resulted in an increase in serum protein from 3.9 g/dL to 4.5 g/dL and a 40% improvement in the Pa[O.sub.2]/Fi[O.sub.2] ratio (179 to 250). The increase in serum protein was associated with a rise in serum albumin ([r.sup.2]=0.52, p [is less than] 0.001) and a weight loss of 2.7 kg ([r.sup.2]=0.27, p=0.02), but not with net fluid balance. The increase in the Pa[O.sub.2]/Fi[O.sub.2] ratio was not associated with changes in weight, fluid balance, or serum protein concentrations.
Conclusion: Combination therapy with albumin and furosemide in hypoproteinemic ALI patients results in increased serum protein concentrations which appear to relate to both administered albumin and degree of diuresis. Improvements in oxygenation do not appear related to diuresis or changes in serum proteins.
Clinical Implications: Treatment of ALI patients with a combination of albumin and furosemide may be monitored by changes in weight. Acute improvements in oxygenation are not accounted for by standard clinical variables, but may be related to unmeasured fluid shifts or changes in extravascular lung water. Further randomized trials of protein and fluid balance manipulation are needed to establish whether this therapy may improve outcomes for patients with acute lung injury.
Grant Support by: Financial support from NHLBI HL 07123.
Greg S Martin, MD(*); R J Mangialardi, MD and G R Bernard, MD, FCCP. The Center for Lung Research, Vanderbilt University, Nashville, TN.
COPYRIGHT 1999 American College of Chest Physicians
COPYRIGHT 2000 Gale Group