ICU Ed and Todd-Cast Old/New: ALBIOS and ARISS
Mar 10, 2026
They dive into recent trials comparing albumin therapy strategies for septic shock and the history of prior landmark studies. They debate biological reasons to use albumin, trial design choices like dosing and targets, and how COVID and enrollment issues affected results. They discuss practical bedside decisions, cost and logistics, and whether current data justify changing practice.
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Subgroup Signals From SAFE and ALBIOS Are Hypothesis Generating
- ALBIOS and SAFE showed no overall mortality benefit from albumin but signaled possible benefit in septic shock subgroups.
- Those subgroup findings were post hoc or secondary, so they were hypothesis generating, not definitive evidence.
Plausibility Drives Albumin Use More Than Proof
- Clinicians justify albumin by plausibility: immunomodulatory effects, natural colloid status, and potential to reduce total crystalloid volume.
- Evidence is weak and confounded; less fluid with colloids may reflect sicker patients receiving more fluids, not causation.
ARISS Used An Albumin Target Rather Than Pure Treatment vs Control
- ARISS tested an albumin-target strategy (target >3.0 g/dL) using 20% albumin dosing tiers rather than simply giving albumin or not.
- This makes the intervention both a therapy and a biochemical target, complicating interpretation.