https://doi.org/10.4081/ecj.2026.15959
19 | Albumin versus crystalloids: fluid distribution and albumin kinetics in pigs ventilated at different mechanical power
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Background. The rationale for using albumin in fluid resuscitation lies in its ability to increase plasma oncotic pressure and optimize hemodynamics and tissue perfusion. However, randomized trials in sepsis have not demonstrated a survival benefit, and the effects of albumin infusion on fluid distribution remain unclear. This study investigates, in healthy pigs, whether albumin infusion modifies Intravascular Fluid Volume (IFV) distribution, compared to crystalloids, and explores albumin kinetics.
Methods. Thirty-nine healthy female pigs ventilated for 48 hours were categorized into four groups based on Mechanical Power (MP) (High ~18 J/min vs. Low ~6 J/min) and fluid type (5% albumin vs. balanced crystalloid) to achieve a set fluid balance: MPLOW-Crystalloid; MPLOW-Albumin; MPHIGH-Crystalloid; and MPHIGH-Albumin. Measurements were taken at baseline and six-hourly thereafter. Outcome variables included IFV and albumin kinetics and other physiological variables.
Results. No significant differences in IFV were observed over time across groups (Figure 1), and at 48 hours: MPLOW-Crystalloid 1.92 (±0.38) L; MPLOW-Albumin 1.86 (±0.37) L; MPHIGH-Crystalloid 1.72 (±0.40) L; MPHIGH-Albumin 2.10 (±0.58) L; p=0.389.
As expected, the theoretical and the actual quantities of albumin in the IFV were higher in the albumin groups compared to the crystalloid groups. Wasted albumin, defined as the difference between theoretical and actual albumin is shown in Figure 2. At 48h, albumin-treated groups demonstrated significantly greater albumin waste, as high as: 62 (±13) % in the MPLOW-Albumin group and 58 (±24) % in the MPHIGH-Albumin group (p<0.001).
Groups receiving albumin had a higher volume of ascites: MPLOW-Crystalloids =261 (±380) mL, MPLOW-Albumin =710 (±664) mL, MPHIGH-Crystalloids =144 (±148) mL, and MPHIGH-Albumin =685 (±651) mL (p=0.034) (Figure 3, Panel A). Additionally, the amount of infused albumin was linearly related to the volume of ascites (p<0.001; R2=0.750) (Figure 3, Panel B).
Conclusions. The 48h-long administration of albumin was associated with higher quantities of wasted albumin and greater volume of ascites.
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