• Oczkowski Simon J W SJW Division of Critical Care Medicine, Department of Medicine, McMaster University, Canada; Department of Critical Care, Hamilton Health Sciences, Ca, Lisa Klotz, Ian Mazzetti, Fayez Alshamsi, Mei Lin Chen, Gary Foster, Maureen O Meade, and Cindy Hamielec.
• Division of Critical Care Medicine, Department of Medicine, McMaster University, Canada; Department of Critical Care, Hamilton Health Sciences, Canada. Electronic address: oczkowsj@mcmaster.ca.
• J Crit Care. 2018 Dec 1; 48: 462-467.

PurposeTo assess the feasibility of a trial evaluating whether hyperoncotic albumin, in addition to diuretics, improves diuresis and facilitates liberation from mechanical ventilation in critically ill adults.Materials And MethodsWe randomized 46 hemodynamically stable patients with hypoalbuminemia, prescribed diuretics by treating clinicians, to receive 100 mL of 25% albumin or 0.9% saline placebo BID, for three days, in blinded fashion. We chose five feasibility measurements: enrolment of 50% of eligible patients, at least one patient/week; administration of study treatment within 2 h of diuretics in 85% of patients; completion of study regimen in 80% of patients; and avoidance of open label albumin in 85% of patients. Clinical outcomes included fluid balance, ventilator-free days, and mortality.ResultsWe randomized 85% of eligible patients. Eighty-four percent received study treatment within 2 h of diuretics, 69% received all doses of study treatment. Study treatment was held in the albumin and placebo groups because of no further need for diuresis (4 vs. 1), hypotension (2 v. 4), and albumin > 35 (1 v. 0). Twenty percent of patients received open-label albumin. Clinical outcomes were similar between groups.ConclusionsThe current study design did not demonstrate feasibility, but can inform the design of a definitive trial.Copyright © 2018 Elsevier Inc. All rights reserved.

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