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

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 ۱-۱۲-year-old children (under mechanical ventilation admitted at ICU randomly allocated to treatment with daily furosemide only (۲ mg/kg) or albumin (۱ gr/kg) add-on therapy to furosemide (۲ 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<۰.۰۰۱), base excess (P<۰.۰۰۱), diastolic blood pressure (P=۰.۰۰۴), heart rate (P=۰.۰۰۹), and potassium (P=۰.۰۰۵) in the intervention group than the control group. The mean of dopamine and potassium doses requirement were ۲.۲۵±۰.۹۵ and ۲.۶۰±۰.۸۹ for the intervention group, and ۱.۰۰±۰.۰۰ and ۲.۰۰±۱.۴۱ for the control group, respectively. The comparison of the two groups showed an insignificant difference between them (P=۰.۲۶ for the dopamine injection and P=۰.۵۷ 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