We designed a clinical index to facilitate the appropriate use of hyperoncotic albumin. We judged the use of hyperoncotic albumin as appropriate or inadequate according to pre-administration serum albumin levels. Then, we calculated the monthly rates of appropriate and inadequate use for our entire hospital, each department, and each doctor who ordered hyperoncotic albumin. Both usage rates improved after the results were reported to the doctors and the cases of inadequate usage were examined. On the other hand, both the number of orders for albumin and the total volume of albumin used in the hospital increased during the investigation period. These results indicate that factors other than pre-administration serum albumin levels play an important role in the judgment of albumin use. Introduction The Tokyo Metropolitan Bokutoh Hospital has 729 acute care hospital beds and is located in eastern Tokyo. Since October 2005, the Department of Transfusion Medicine in our hospital has managed albumin products with blood products such as red cell concentrates (RCC), fresh frozen plasma (FFP), platelet concentrates (PC), etc. In Japan, the Japanese Medical Service established the albumin-to-red-cell transfusion ratio (ALB/RCC ratio) for health insurance purposes; ratios under 2.0 are required for transfusion control. The use of 3 g of albumin is defined as 1 unit. Albumin use in our hospital has satisfied the ALB/RCC ratio requirement from 2005 to the present, ranging 1.6–1.8 units (Figure 1A). However, despite conditions of good transfusion control, inadequate use of albumin was noted in some cases in our hospital. Moreover, the amount of albumin used in our hospital did not decrease. Isotonic albumin was used in the emergency department for patients with circulatory blood loss such as massive hemorrhage, severe burns, etc. Therefore, accurately judging the appropriate dosage and reasonable use of albumin is difficult. On the other hand, hyperoncotic albumin is used for relieving colloid oncotic pressure. Many doctors tend to confirm serum albumin levels and plan the dosage of albumin accordingly. However, we decided to allow doctors to promote the proper use of hyperoncotic albumin. Moreover, there are much fewer reports on hyperoncotic albumin use than reports on isotonic albumin use. Therefore, we attempted to create a new clinical index using serum albumin values recorded before hyperoncotic albumin use. We devised a clinical index to calculate the appropriate (pre-administration serum albumin level 2.6 g/dL) per month, and announce the results to the medical doctors every month. In this report, we review the influence of this clinical index and its pronouncement on hyperoncotic albumin use in our hospital.
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机译：我们设计了一种临床指标，以促进高渗白蛋白的适当使用。根据给药前血清白蛋白水平，我们判断是否使用高渗白蛋白是适当的还是不足的。然后，我们计算了整个医院，每个部门以及订购高渗白蛋白的每个医生每月适当和不足使用量的比率。将结果报告给医生并检查使用不充分的情况后，两种使用率均得到改善。另一方面，在调查期间，医院的白蛋白订单数量和白蛋白总量均增加了。这些结果表明，给药前血清白蛋白水平以外的因素在白蛋白使用的判断中起重要作用。简介东京都国立医院设有729张急诊病床，位于东京东部。自2005年10月以来，我们医院的输血科一直在管理血液蛋白的白蛋白产品，例如红细胞浓缩物（RCC），新鲜冷冻血浆（FFP），血小板浓缩物（PC）等。在日本，日本医疗服务建立用于健康保险目的的白蛋白与红细胞输注比率（ALB / RCC比率）;输血控制需要低于2.0的比率。将3g白蛋白的使用定义为1单位。从2005年至今，我们医院使用的白蛋白已满足ALB / RCC比率的要求，范围为1.6-1.8单位（图1A）。然而，尽管有良好的输血控制条件，但在我们医院的某些病例中仍发现白蛋白使用不足。而且，我们医院使用的白蛋白数量没有减少。等渗白蛋白被用于急诊室，用于大量失血，严重烧伤等循环失血的患者。因此，很难正确判断白蛋白的适当剂量和合理使用。另一方面，高渗白蛋白用于缓解胶体渗透压。许多医生倾向于确认血清白蛋白水平，并据此计划白蛋白的剂量。但是，我们决定允许医生促进高渗白蛋白的正确使用。此外，关于高渗白蛋白使用的报道要比等渗白蛋白使用的报道少。因此，我们尝试使用高渗白蛋白使用之前记录的血清白蛋白值来创建新的临床指标。我们设计了一个临床指标来计算每月适当的剂量（给药前血清白蛋白水平2.6 g / dL），并每月将结果公布给医生。在本报告中，我们回顾了该临床指数及其声明对我们医院使用高渗白蛋白的影响。
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