A number of recent studies have addressed the use of "prophylactic" hypervolemia. In one prospective, randomized trial, routine administration of albumin to keep central venous pressure greater than 7 mmHg did not improve cerebral blood flow or outcome (80). Another report suggested that outcome worsened after the discontinuation of the routine use of albumin (81). Due to concern about hyperchloremic metabolic acidosis developing after administration of large amounts of saline, some clinicians partially replace chloride with acetate.
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