Volume expansion is often necessary after cardiac 
surgery, and albumin is often administered. 
Albumin has been used for fluid resuscitation in the 
OR and ICU, since 1940 (Rabin, Joseph2018) Its 
usage gained prominence based on the classic 
descriptions of trans vascular exchange by Earnest 
Starling who purported that colloids such as 
albumin should be more effective at increasing 
depleted intravascular volume due to their relative 
vascular membrane impermeability when 
compared to crystalloids such as saline. 
In the pediatric cardiac intensive care unit (PCICU) 
at Aswan Heart Centre, there were albumin usage 
is high without restriction, in addition to financial 
effect because the price of albumin vials has
increased because of global economic changes. so, 
cost cost-effectiveness quality improvement 
project was started, and applying restrictive 
guidelines from the last two weeks of June 2022