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Anthony Charles, MD; Maryanne Purtill, MD; Sharon Dickinson, RN, MSN, CCRN; Michael Kraft, PharmD; Melissa Pleva, PharmD; Craig Meldrum, BBA; Lena Napolitano, MD

Arch Surg. 2008;143(10):935-939.

Hypothesis  Restrictive albumin use guidelines in the surgical intensive care unit (SICU) will not increase mortality and will result in cost savings.

Design  Prospective cohort study.

Setting  Tertiary teaching hospital.

Patients  All patients admitted to the SICU from July 1, 2004, through July 1, 2005, were included in this study.

Interventions  Patients in the first 3 quarters of the study were treated with no restriction on albumin use. An organized educational program was initiated by the new intensivist-led critical care team and directed toward the residents, nursing staff, and primary surgical teams. Appropriate albumin use guidelines were instituted in the last quarter.

Main Outcome Measures  Prospective clinical and outcome data were collected. Albumin use data and costs were obtained from the pharmacy prospective database.

Results  A total of 1361 patients were included in the study. A statistically significant reduction in albumin use (54%) was found in the fourth quarter (P = .004), and a substantial cost saving was realized (56% reduction in cost) with the albumin use guidelines. Restrictive use of albumin had no negative impact on ICU mortality. Mean Acute Physiology and Chronic Health Evaluation III scores on ICU day 1 were not different. No significant difference in mean ICU length of stay was noted. Maintained reduction in the use of albumin was documented during the next 6 quarters.

Conclusions  The implementation of albumin use guidelines during critical care resuscitation using an educational approach in a SICU is associated with reduced albumin use, significant cost savings, and no negative impact on ICU outcome. Continued educational efforts promoting evidence-based practices in the ICU are warranted.

Author Affiliations: Department of Surgery, Division of Acute Care Surgery, University of Michigan, Ann Arbor.

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Albumin Use Guidelines and Outcome in a Surgical Intensive Care Unit—Invited Critique
William G. Cheadle
Arch Surg. 2008;143(10):939.
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