Background It remains uncertain whether the choice of resuscitationfluid for patients in intensive care units (ICUs) affects survival.We conducted a multicenter, randomized, double-blind trial tocompare the effect of fluid resuscitation with albumin or salineon mortality in a heterogeneous population of patients in theICU.
Methods We randomly assigned patients who had been admittedto the ICU to receive either 4 percent albumin or normal salinefor intravascular-fluid resuscitation during the next 28 days.The primary outcome measure was death from any cause duringthe 28-day period after randomization.
Results Of the 6997 patients who underwent randomization, 3497were assigned to receive albumin and 3500 to receive saline;the two groups had similar baseline characteristics. There were726 deaths in the albumin group, as compared with 729 deathsin the saline group (relative risk of death, 0.99; 95 percentconfidence interval, 0.91 to 1.09; P=0.87). The proportion ofpatients with new single-organ and multiple-organ failure wassimilar in the two groups (P=0.85). There were no significantdifferences between the groups in the mean (±SD) numbersof days spent in the ICU (6.5±6.6 in the albumin groupand 6.2±6.2 in the saline group, P=0.44), days spentin the hospital (15.3±9.6 and 15.6±9.6, respectively;P=0.30), days of mechanical ventilation (4.5±6.1 and4.3±5.7, respectively; P=0.74), or days of renal-replacementtherapy (0.5±2.3 and 0.4±2.0, respectively; P=0.41).
Conclusions In patients in the ICU, use of either 4 percentalbumin or normal saline for fluid resuscitation results insimilar outcomes at 28 days.
Source Information
The Saline versus Albumin Fluid Evaluation (SAFE) Study is a collaboration of the Australian and New Zealand Intensive Care Society Clinical Trials Group, the Australian Red Cross Blood Service, and the George Institute for International Health. The writing committee (Simon Finfer, M.B., B.S., Rinaldo Bellomo, M.B., B.S., M.D., Neil Boyce, M.B., B.S., Ph.D., Julie French, R.N., John Myburgh, M.B., B.Ch., Ph.D., and Robyn Norton, Ph.D., M.P.H.) takes responsibility for the content of this article.
Address reprint requests to Dr. Finfer at ANZICS CTG, Level 3, 10 Ievers St., Carlton, VIC 3053, Australia, or at ctg{at}anzics.com.au.
Fluid Resuscitation in the Intensive Care Unit
Haynes G. R., Berman K. E., Neff T. A., Stocker R., Spahn D. R., Barone J. E., Primack W. A., Estes K., Walter E. C., Wendorf R., Kim Y., Finfer S., Boyce N., Norton R., Cook D.
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N Engl J Med 2004;
351:1905-1908, Oct 28, 2004.
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