Re-evaluating albumin use in traumatic brain injury
Vincent, Jean-Louis (Hôpital Universitaire de Bruxelles)
Ferrer, Ricard (Universitat Autònoma de Barcelona. Departament de Medicina)
Taccone, Fabio Silvio (Hôpital Universitaire de Bruxelles)
Wiedermann, Christian J. (Claudiana College of Health Professions (Bolzano, Itàlia))
Reinstrup, Peter (SUS University Hospital (Lund, Suècia))

Date:	2025
Abstract:	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.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Albumin ; Traumatic brain injury ; Intracranial pressure ; Outcomes
Published in:	Journal of Intensive Care, Vol. 13 (august 2025) , ISSN 2052-0492

DOI: 10.1186/s40560-025-00813-y
PMID: 40750906

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