Plasma Volume Oscillations During Intravenous Infusion of Hyper-Oncotic Albumin

TL;DR

This study found that infusing hyper-oncotic albumin causes low-frequency oscillations in plasma volume, which could impact cardiovascular measurements.

Contribution

The study demonstrates that plasma volume oscillations occur during hyper-oncotic albumin infusion, a novel observation in clinical fluid dynamics.

Findings

Oscillations occurred with a dominant frequency of 144 ± 42 minutes and amplitude of 1.8 ± 0.9%.

The highest amplitude oscillations caused a 6% plasma volume fluctuation, equivalent to 180 mL.

Oscillations were consistent across different clinical settings and could affect cardiovascular function measurements.

Abstract

Low-frequency oscillations of blood components have been observed when the plasma is diluted by crystalloid fluid. The present study explores whether oscillations also occur during the infusion of hyper-oncotic albumin 20%. For this purpose, the hemoglobin-derived plasma dilution, plasma colloid osmotic pressure, and plasma albumin concentration were measured on 15 occasions over 5 h in 72 volunteers. All of them received 3 mL/kg of albumin 20% over 30 min in various clinical settings. Quality checks excluded 35% of the concentration–time curves, leaving 137 for analysis. Fourier transforms applied to the residuals after curve-fitting showed that the dominating frequency was 144 ± 42 min (mean ± SD), corresponding to 0.007 Hz and a wave amplitude of 1.8 ± 0.9%. The highest percentile of the amplitudes corresponded to a “peak-to-peak” variation in the plasma volume by 6%, which corresponds to a fluctuation of 180 mL, or 45% of the maximum volume expansion following the infusion of albumin 20%. Differences between settings (volunteers, surgery, postoperative, and post-burn) were small. In conclusion, oscillations with very low frequency occurred after infusion of albumin 20%. They varied the plasma volume by 3.6% and by up to 6% in the percentile with the highest amplitudes. The oscillations are large enough to affect measurements of cardiovascular function.

Figures