INTRODUCTION: Use of albumin is suggested for some patients with shock, but preferences for its use may vary among intensive care unit (ICU) physicians. METHODS: We conducted an international online survey of ICU physicians with 20 questions about their use of albumin and their opinion towards a randomised trial among adults with shock comparing the use versus no use of albumin. RESULTS: A total of 1248 respondents participated, with a mean response rate of 37%, ranging from 18% to 75% across 21 countries. Respondents mainly worked in mixed ICUs and 92% were specialists in intensive care medicine. The reported use of albumin in general shock varied as 18% reported 'almost never', 22% 'rarely', 34% 'occasionally', 22% 'frequently' and 4% 'almost always' using albumin. In septic shock, 19% reported 'almost never', 22% 'rarely', 29% 'occasionally', 22% 'frequently' and 7% 'almost always' using albumin. Physicians' preferences were more consistent for haemorrhagic- and cardiogenic shock, with more than 45% reporting 'almost never' using albumin. While the reported use of albumin for other purposes than resuscitation was infrequent (40%-85% reported 'almost never' for five other indications), the most frequent other indications were low serum albumin levels and improvement of the efficacy of diuretics. Most respondents (93%) would randomise adult ICU patients with shock to a trial of albumin versus no albumin. CONCLUSIONS: In this international survey, the reported preferences for the use of albumin in adult ICU patients with shock varied considerably among surveyed ICU physicians. The support for a future randomised trial was high.

Australian and New Zealand Intensive Care Research Centre Monash University Melbourne Victoria Australia

Biomedical Sciences Department Humanitas University Pieve Emanuele Milan Italy

Centre for Intensive Care and Perioperative Medicine Jagiellonian University Medical College Krakow Poland

Clinic of Anaesthesiology and Intensive Care Vilnius University Faculty of Medicine Vilnius Lithuania

Collaboration for Research in Intensive Care Copenhagen Denmark

Department of Anaesthesia and Intensive Care IRCCS Humanitas Research Hospital Rozzano Italy

Department of Anaesthesia and Intensive Care Lillebaelt Hospital Kolding Denmark

Department of Anaesthesia Critical Care Medicine and Pain Medicine Kuwait Extracorporeal Life Support Program Al Amiri Hospital Ministry of Health Kuwait City Kuwait

Department of Anaesthesiology and Critical Care Medicine Landspitali The National University Hospital of Iceland Reykjavik Iceland

Department of Anaesthesiology Perioperative Medicine and Intensive Care J E Purkinje University Masaryk Hospital Usti nad Labem Czech Republic

Department of Clinical Medicine Faculty of Health Sciences University of Copenhagen Copenhagen Denmark

Department of Clinical Sciences Danderyd Hospital Karolinska Institutet Solna Sweden

Department of Critical Care University Medical Center Groningen University of Groningen Groningen The Netherlands

Department of Critical Care University of Melbourne Melbourne Victoria Australia

Department of Intensive Care Cantonal Hospital of Lucerne Lucerne Switzerland

Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark

Department of Intensive Care Inselspital Bern University Hospital University of Bern Bern Switzerland

Department of Intensive Care Jikei University Hospital Tokyo Japan

Department of Intensive Care Medicine Ghent University Hospital Ghent Belgium

Department of Intensive care Royal Victoria Hospital Belfast UK

Department of Intensive Care Tampere University Hospital Wellbeing Services County of Pirkanmaa and Tampere University Faculty of Medicine and Health Technology Tampere Finland

Department of Internal Medicine College of Medicine and Health Sciences United Arab Emirates University Al Ain United Arab Emirates

Department of Pulmonary and Critical Care Dokuz Eylül University Izmir Turkey

Division of Emergencies and Critical Care Oslo University Hospital Oslo Norway

Faculty of Medicine University of Iceland Reykjavik Iceland

Intensive Care Department King Abdulaziz Medical City Ministry of National Guard Health Affairs King Abdullah International Medical Research Center College of Medicine King Saud Bin Abdulaziz University for Health Sciences Riyadh Saudi Arabia

Intensive Care Unit Wellington Hospital Wellington New Zealand

King's College London Guy's and St Thomas' Hospital London London UK

Medical Research Institute of New Zealand Wellington New Zealand

Military Hospital Krakow Poland

Outcomes Research Consortium Cleveland Ohio USA

Section on Critical Care Medicine Department of Anesthesiology Wake Forest School of Medicine Atrium Health Wake Forest Baptist Medical Center Winston Salem North Carolina USA

University of Tartu Tartu Estonia

Acta Anaesthesiol Scand. 2025 Jan;69(1):e14557. doi: 10.1111/aas.14557. PubMed

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