TY  - JOUR
T1  - Evaluation of Human Serum Albumin in Neurocritical Care: A Narrative Review of Current Applications and Treatment Challenges 
AU  - Jin, Songgen
AU  - Luo, Yunpeng
AU  - Yang, Songliu
AU  - Wu, Shixing
AU  - Wang, Changsong
JF  - Journal of Translational Critical Care Medicine
VL  - 8
IS  - 3
SN  - 2590-3438
SP  - e00003S
EP  - e00003S
Y1  - 2026-09-30
DO  - 10.14218/JTCCM.2026.00003S
UR  - https://www.xiahepublishing.com/2590-3438/JTCCM-2026-00003S
AB  - Human serum albumin (HSA) is a multifunctional carrier protein that helps maintain vascular barrier integrity and intravascular fluid homeostasis and has long been used in the management of critically ill patients, including those with acute brain injury. HSA is thought to exert neuroprotective effects through four complementary mechanisms: oncotic/volume expansion and hemodilution, antioxidant and anti-inflammatory effects, HSA-nitric oxide-mediated antithrombotic activity, and glycocalyx stabilization, although the precise pathways remain incompletely understood. Despite its biological rationale, the clinical efficacy of HSA in severe neurological disorders remains inconclusive, and few guidelines provide specific recommendations for its use in neurological care. This uncertainty stems primarily from the complex etiology and heterogeneous pathophysiology of neurological disorders, as well as inconsistent findings across existing studies. This narrative review aims to summarize the current evidence on HSA use in traumatic brain injury, acute ischemic stroke, and aneurysmal subarachnoid hemorrhage, identify existing knowledge gaps, and provide insights for future research and clinical practice. We screened records from PubMed, Embase, the Cochrane Library, CNKI, and Yiigle, as well as ClinicalTrials.gov, ChiCTR, and ChinaDrugTrials. A total of 29 human and animal studies were included. Collectively, available evidence supports a biological rationale for HSA therapy in neurocritical care, yet its clinical benefit remains incompletely established and substantial challenges persist. Prospective randomized controlled trials are warranted to clarify the efficacy and safety of HSA and determine whether preliminary encouraging findings can inform standardized guidelines and expert consensus recommendations, particularly regarding optimal concentration, timing, and patient selection.