Cohort Study of Albumin versus Lactated Ringer's for Postoperative Cardiac Surgery Fluid Resuscitation in the Intensive Care Unit

Ryan Fink, Andrew Young, Norbert Yanez, Marissa Hom, Jennifer Mai, Miriam Treggiari, Matthias Merkel

Research output: Contribution to journalArticle

Abstract

Purpose: A new postcardiac surgery fluid resuscitation strategy was implemented in our cardiovascular intensive care unit (CVICU) to implement evidence-based practice. We transitioned from a primarily albumin fluid–based strategy to a lactated Ringer's fluid–based strategy. We sought to determine whether a new postoperative fluid resuscitation strategy significantly altered the fluid composition for postcardiac surgery patients and what effect that would have on fluid resuscitation costs. Secondary outcomes included various clinical parameters. Methods: This was a retrospective, before-and-after cohort study of postcardiac surgery patients in an academic quaternary care intensive care unit (ICU) during two different 3-month time intervals. A total of 192 patients were studied: 108 pre-intervention and 84 post intervention. The intervention consisted of surveying stakeholders regarding potential concerns of reducing albumin use, an educational intervention addressing those concerns, and removing albumin from the routine postcardiac surgery ICU admission order set. Results: In the post intervention time period, albumin use decreased significantly compared to pre-invention (p<0.01), and lactated Ringer's volume increased significantly (p<0.01). However, total volume administered for resuscitation was not significantly different pre- and post intervention (1129 ml vs. 1369 ml, p=0.136). There were a net-cost savings between the pre-intervention and post intervention period (3 mo) of $30,549.20, with the albumin reduction accounting for most of those savings. Secondary outcomes were not significantly different between groups. Conclusions: An albumin fluid reduction strategy was successful in reducing the amount of albumin fluid used for postcardiac surgery patients and resulted in substantial cost savings.

Original languageEnglish (US)
Pages (from-to)1241-1249
Number of pages9
JournalPharmacotherapy
Volume38
Issue number12
DOIs
StatePublished - Dec 1 2018

Fingerprint

Resuscitation
Thoracic Surgery
Intensive Care Units
Albumins
Cohort Studies
Cost Savings
Evidence-Based Practice
Ringer's lactate
Costs and Cost Analysis

Keywords

  • albumin
  • cardiac surgery
  • cost reduction
  • crystalloid
  • lactated Ringer's

ASJC Scopus subject areas

  • Pharmacology (medical)

Cite this

Cohort Study of Albumin versus Lactated Ringer's for Postoperative Cardiac Surgery Fluid Resuscitation in the Intensive Care Unit. / Fink, Ryan; Young, Andrew; Yanez, Norbert; Hom, Marissa; Mai, Jennifer; Treggiari, Miriam; Merkel, Matthias.

In: Pharmacotherapy, Vol. 38, No. 12, 01.12.2018, p. 1241-1249.

Research output: Contribution to journalArticle

@article{8d5d69192ff243e7946156918c3bc097,
title = "Cohort Study of Albumin versus Lactated Ringer's for Postoperative Cardiac Surgery Fluid Resuscitation in the Intensive Care Unit",
abstract = "Purpose: A new postcardiac surgery fluid resuscitation strategy was implemented in our cardiovascular intensive care unit (CVICU) to implement evidence-based practice. We transitioned from a primarily albumin fluid–based strategy to a lactated Ringer's fluid–based strategy. We sought to determine whether a new postoperative fluid resuscitation strategy significantly altered the fluid composition for postcardiac surgery patients and what effect that would have on fluid resuscitation costs. Secondary outcomes included various clinical parameters. Methods: This was a retrospective, before-and-after cohort study of postcardiac surgery patients in an academic quaternary care intensive care unit (ICU) during two different 3-month time intervals. A total of 192 patients were studied: 108 pre-intervention and 84 post intervention. The intervention consisted of surveying stakeholders regarding potential concerns of reducing albumin use, an educational intervention addressing those concerns, and removing albumin from the routine postcardiac surgery ICU admission order set. Results: In the post intervention time period, albumin use decreased significantly compared to pre-invention (p<0.01), and lactated Ringer's volume increased significantly (p<0.01). However, total volume administered for resuscitation was not significantly different pre- and post intervention (1129 ml vs. 1369 ml, p=0.136). There were a net-cost savings between the pre-intervention and post intervention period (3 mo) of $30,549.20, with the albumin reduction accounting for most of those savings. Secondary outcomes were not significantly different between groups. Conclusions: An albumin fluid reduction strategy was successful in reducing the amount of albumin fluid used for postcardiac surgery patients and resulted in substantial cost savings.",
keywords = "albumin, cardiac surgery, cost reduction, crystalloid, lactated Ringer's",
author = "Ryan Fink and Andrew Young and Norbert Yanez and Marissa Hom and Jennifer Mai and Miriam Treggiari and Matthias Merkel",
year = "2018",
month = "12",
day = "1",
doi = "10.1002/phar.2195",
language = "English (US)",
volume = "38",
pages = "1241--1249",
journal = "Pharmacotherapy",
issn = "0277-0008",
publisher = "Pharmacotherapy Publications Inc.",
number = "12",

}

TY - JOUR

T1 - Cohort Study of Albumin versus Lactated Ringer's for Postoperative Cardiac Surgery Fluid Resuscitation in the Intensive Care Unit

AU - Fink, Ryan

AU - Young, Andrew

AU - Yanez, Norbert

AU - Hom, Marissa

AU - Mai, Jennifer

AU - Treggiari, Miriam

AU - Merkel, Matthias

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Purpose: A new postcardiac surgery fluid resuscitation strategy was implemented in our cardiovascular intensive care unit (CVICU) to implement evidence-based practice. We transitioned from a primarily albumin fluid–based strategy to a lactated Ringer's fluid–based strategy. We sought to determine whether a new postoperative fluid resuscitation strategy significantly altered the fluid composition for postcardiac surgery patients and what effect that would have on fluid resuscitation costs. Secondary outcomes included various clinical parameters. Methods: This was a retrospective, before-and-after cohort study of postcardiac surgery patients in an academic quaternary care intensive care unit (ICU) during two different 3-month time intervals. A total of 192 patients were studied: 108 pre-intervention and 84 post intervention. The intervention consisted of surveying stakeholders regarding potential concerns of reducing albumin use, an educational intervention addressing those concerns, and removing albumin from the routine postcardiac surgery ICU admission order set. Results: In the post intervention time period, albumin use decreased significantly compared to pre-invention (p<0.01), and lactated Ringer's volume increased significantly (p<0.01). However, total volume administered for resuscitation was not significantly different pre- and post intervention (1129 ml vs. 1369 ml, p=0.136). There were a net-cost savings between the pre-intervention and post intervention period (3 mo) of $30,549.20, with the albumin reduction accounting for most of those savings. Secondary outcomes were not significantly different between groups. Conclusions: An albumin fluid reduction strategy was successful in reducing the amount of albumin fluid used for postcardiac surgery patients and resulted in substantial cost savings.

AB - Purpose: A new postcardiac surgery fluid resuscitation strategy was implemented in our cardiovascular intensive care unit (CVICU) to implement evidence-based practice. We transitioned from a primarily albumin fluid–based strategy to a lactated Ringer's fluid–based strategy. We sought to determine whether a new postoperative fluid resuscitation strategy significantly altered the fluid composition for postcardiac surgery patients and what effect that would have on fluid resuscitation costs. Secondary outcomes included various clinical parameters. Methods: This was a retrospective, before-and-after cohort study of postcardiac surgery patients in an academic quaternary care intensive care unit (ICU) during two different 3-month time intervals. A total of 192 patients were studied: 108 pre-intervention and 84 post intervention. The intervention consisted of surveying stakeholders regarding potential concerns of reducing albumin use, an educational intervention addressing those concerns, and removing albumin from the routine postcardiac surgery ICU admission order set. Results: In the post intervention time period, albumin use decreased significantly compared to pre-invention (p<0.01), and lactated Ringer's volume increased significantly (p<0.01). However, total volume administered for resuscitation was not significantly different pre- and post intervention (1129 ml vs. 1369 ml, p=0.136). There were a net-cost savings between the pre-intervention and post intervention period (3 mo) of $30,549.20, with the albumin reduction accounting for most of those savings. Secondary outcomes were not significantly different between groups. Conclusions: An albumin fluid reduction strategy was successful in reducing the amount of albumin fluid used for postcardiac surgery patients and resulted in substantial cost savings.

KW - albumin

KW - cardiac surgery

KW - cost reduction

KW - crystalloid

KW - lactated Ringer's

UR - http://www.scopus.com/inward/record.url?scp=85058091216&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85058091216&partnerID=8YFLogxK

U2 - 10.1002/phar.2195

DO - 10.1002/phar.2195

M3 - Article

C2 - 30403299

AN - SCOPUS:85058091216

VL - 38

SP - 1241

EP - 1249

JO - Pharmacotherapy

JF - Pharmacotherapy

SN - 0277-0008

IS - 12

ER -