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Re-evaluating albumin use in traumatic brain injury

par Vincent, Jean Louis ;Roca, Ricard Ferrer;Taccone, Fabio ;Wiedermann, Christian;Reinstrup, Peter
Référence Journal of Intensive Care, 13, 1, 43
Publication Publié, 2025

Lettre à l'éditeur

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Résumé :

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.