Use of Human Serum Albumin in Critically Ill Patients: A Narrative Review - PubMed

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Human serum albumin (HSA) is crucial for oncotic pressure, endothelial protection, drug binding, and immune modulation.
HSA combined with vasoconstrictors improves renal function and survival in hepatorenal syndrome (HRS).
In spontaneous bacterial peritonitis (SBP), albumin reduces acute kidney injury and mortality in high-risk cirrhotic patients.
Post-paracentesis albumin reduces circulatory dysfunction and may enhance survival in cirrhosis.
For septic shock, albumin shows no overall mortality benefit over crystalloids but may offer hemodynamic advantages in specific subgroups.
In ARDS, albumin improves oxygenation in hypoalbuminemic patients without survival benefits.
During major surgery, albumin reduces fluid needs and postoperative complications, especially in hypoalbuminemic individuals.
In acute brain injury, albumin's role is controversial—beneficial in cerebral hemorrhage but may worsen traumatic brain injury outcomes.
In trauma and ECMO patients, albumin may stabilize hemodynamics and improve outcomes in selected cases.
Inappropriate albumin use is common; evidence on optimal concentration, dose, timing, and patient selection is limited.

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