The Use of Albumin Add-on Therapy to Loop Diuretic for the Management of Pleural Effusion in Mechanically Ventilated Ill Children

Abstract

Background: Pleural effusion (PE) is common in children with acute illness that are admitted to the intensive care unit (ICU). The present study aimed to investigate the efficacy of albumin add-on therapy to furosemide in contrast to furosemide treatment only for treating transudative PE.Methods: The present randomized clinical trial was conducted on fifty 1-12-year-old children (under mechanical ventilation admitted at ICU randomly allocated to treatment with daily furosemide only (2 mg/kg) or albumin (1 gr/kg) add-on therapy to furosemide (2 mg/kg) for three days. The vital signs, venous blood gas, the pleural effusion volume, serum potassium level, potassium, and dopamine requirement were measured daily and compared between the groups.Results: Comparison of the two groups showed a significant decrease in the pleural fluid volume (P<0.001), base excess (P<0.001), diastolic blood pressure (P=0.004), heart rate (P=0.009), and potassium (P=0.005) in the intervention group than the control group. The mean of dopamine and potassium doses requirement were 2.25±0.95 and 2.60±0.89 for the intervention group, and 1.00±0.00 and 2.00±1.41 for the control group, respectively. The comparison of the two groups showed an insignificant difference between them (P=0.26 for the dopamine injection and P=0.57 for the potassium prescription).Conclusion: As the first study worldwide, considerable benefits were observed in the use of albumin and furosemide combination among PICU-admitted children under mechanical ventilation who required negative fluid balance. In addition, no hemodynamic instability or death was reported. During this short-term follow-up period, a satisfactory percentage of children were separated from the ventilator and transferred to the ward.

Keywords

• loop diuretics
• albumin infusion
• mechanical ventilation
• intensive care