Sistema de Salut de Catalunya
Institut Català de la Salut
[Vincent JL, Taccone FS] Department of Intensive Care, Erasme Hospital, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (ULB), Brussels, Belgium. [Ferrer R] Servei de Medicina Intensa, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Grup de Recerca de Shock, Disfunció Orgànica i Ressuscitació, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain. [Wiedermann CJ] Institute of General Practice and Public Health, Claudiana College of Health Professions, Bolzano, Italy. [Reinstrup P] Department of Intensive and Perioperative Care, SUS University Hospital, Lund, Sweden
Vall d'Hebron Barcelona Hospital Campus
2025-10-06T09:50:28Z
2025-10-06T09:50:28Z
2025-08-01
Albumin; Intracranial pressure; Outcomes
Albúmina; Presión intracraneal; Resultados
Albúmina; Pressió intracranial; Resultats
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.
This publication was supported by Grifols.
Article
Versió publicada
Anglès
Dany cerebral - Tractament; Cap - Ferides i lesions - Tractament; Albúmina - Ús terapèutic; Fluidoteràpia; DISEASES::Nervous System Diseases::Central Nervous System Diseases::Brain Diseases::Brain Injuries::Brain Injuries, Traumatic; Other subheadings::Other subheadings::/therapy; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Therapeutics::Drug Therapy::Fluid Therapy; CHEMICALS AND DRUGS::Amino Acids, Peptides, and Proteins::Proteins::Albumins; Other subheadings::Other subheadings::/therapeutic use; ENFERMEDADES::enfermedades del sistema nervioso::enfermedades del sistema nervioso central::enfermedades cerebrales::lesiones encefálicas::lesiones encefálicas traumáticas; Otros calificadores::Otros calificadores::/terapia; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::terapéutica::farmacoterapia::fluidoterapia; COMPUESTOS QUÍMICOS Y DROGAS::aminoácidos, péptidos y proteínas::proteínas::albúminas; Otros calificadores::Otros calificadores::/uso terapéutico
BMC
Journal of Intensive Care;13(1)
https://doi.org/10.1186/s40560-025-00813-y
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
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