To re-evaluate the effects of 25% albumin on intracranial pressure (ICP) using real-world data.
Approach:
Patient Selection: Patients aged ≥ 18 years with invasive ICP monitoring who received at least one dose of 25% albumin and had at least three ICP measurements before and after infusion were selected.
Data Analysis: Pre- and post-infusion ICP and mean arterial pressure (MAP) values were summarized and compared using the Wilcoxon signed-rank test.
Subgroup Stratification: Patients were stratified into two subgroups based on baseline ICP: elevated (> 15 mmHg) and normal (≤ 15 mmHg).
Key Findings:
Nineteen patients met the inclusion criteria; 18 were analyzed after excluding one for data artifacts.
Median ICP values before and after albumin administration were 8 mmHg and 10 mmHg, respectively (p = 0.96).
In patients with elevated ICP, median ICP decreased from 24 mmHg to 17.5 mmHg post-infusion (p = 0.106).
In patients with normal ICP, median ICP increased slightly from 7.0 mmHg to 8.0 mmHg post-infusion.
MAP increased from 74.8 mmHg to 84.5 mmHg after albumin administration.
Interpretation:
The trend toward ICP reduction in patients with elevated baseline ICP suggests potential oncotic effects of hyperoncotic solutions, while the modest MAP increase indicates volume-expanding effects without exacerbating intracranial hypertension.
Limitations:
Small sample size limits statistical power.
Indications for albumin administration and concurrent ICP-lowering interventions were not retrieved.
Heterogeneity of diagnoses may impact interpretation.
Stratification threshold of 15 mmHg may complicate interpretation of results.
Conclusion:
This exploratory analysis suggests that 25% albumin does not worsen intracranial hypertension and may improve hemodynamic status, indicating the need for larger prospective evaluations.
