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

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. The present randomized clinical trial was conducted on fifty 1-12-year-old children (under mechanical ventilation admitted at ICU randomly allocated to treatment with daily furosemide only (2 mg/kg) or albumin (1 gr/kg) add-on therapy to furosemide (2 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. Comparison of the two groups showed a significant decrease in the pleural fluid volume (P<0.001), base excess (P<0.001), diastolic blood pressure (P=0.004), heart rate (P=0.009), and potassium (P=0.005) in the intervention group than the control group. The mean of dopamine and potassium doses requirement were 2.25±0.95 and 2.60±0.89 for the intervention group, and 1.00±0.00 and 2.00±1.41 for the control group, respectively. The comparison of the two groups showed an insignificant difference between them (P=0.26 for the dopamine injection and P=0.57 for the potassium prescription). 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.