extremely ill patients in the inten...

extremely ill patients in the intensive care unit (ICU) oftentimes require fluid resuscitation to restore intravascular turn The choice of fluid to use for resuscitation varies widely, with more [i]or[/i] less centers preferring crystalloid solutions while others use albumin or other colloid solutions. Smaller comparison studies of the effectiveness of these fluids have produc conflicting outcomes and some larger meta-analyses have take rise to differing conclusions. The Saline versus Albumin Fluid Evaluation (SAFE) close attention investigators designed a large randomized investigation to compare saline with albumin for fluid resuscitation.

This multicenter trial was leadershiped at 16 academic hospital ICUs, enrolling 7000 patients who were randomized to intravenous saline or 4 percent albumin when fluid resuscitation was required. Special masking bottle were used in such a manner physicians would be blinded to the assigned fluid. Use of line products, enteral or parenteral nutrition, and specific electrolyte replacement fluids were left to the discretion of the treating physicians. Resuscitation fluids outside of the randomized assignment were used in 88 percent of the albumin form into groups and 10.7 percent of the saline arrange Twenty-eight days after randomization, follow-up survival data were missing for 1 percent of listed patients.

Patients randomized to albumin received a smaller total dimensions of resuscitation fluids during the first several days of ICU treatment, had a lower mean heart rate, the same mean arterial squeezing and a significantly higher central venous squeezing compared with patients who received intravenous saline.

The mortality rate after 28 days was not significantly different between the albumin form into groups (20.9 percent) and the saline assemblage (21.1 percent). Slightly more patients assigned to albumin (32 percent) had an ICU stay extended beyond the 28 days compared with the saline assign places to (2.5 per-cent). The mean continuance of stay in the ICU and overall stay in the hospital were not significantly different between the pair groups. In the subgroup of ICU patients admitted because of trauma, there was a higher mortality rate among those randomized to albumin (136 percent) compared with the saline form into groups (10 percent), which was of borderline statistical significance.

The authors close that use of albumin or saline for fluid resuscitation in ICU patients does not affect the overall mortality rate at 28 days after randomization.

The SAFE contemplation Investigators. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J M May 27 2004;350:2247-56

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