NEJM
March 27, 2004
A Comparison of Albumin and Saline for Fluid Resuscitation in the Intensive Care Unit.
Mazen Kherallah
Summarized by:
What was the research question?
Does fluid resuscitation with 4% albumin, compared to normal saline, affect mortality for patients in the ICU?
How did they do it?
A randomized, double blinded, controlled trial in 16 ICUs in Australia.
6997 ICU patients were randomized to receive 4% albumin (3497 patients) or 0.9% sodium chloride (3500 patients) for intravascular-fluid resuscitation.
Stratified by center and according to whether there was a diagnosis of trauma.
The primary outcome measure was 28-day mortality after randomization.
What did they find?
28-day mortality was not significantly different between the albumin group and the saline group (20.9% vs. 21.1%, P=0.87).
There was a trend towards a better 28-day mortality in patients with severe sepsis (30.7% vs 35.3%, P=0.09), and a trend towards worse 28-day mortality in patients with trauma (13.6% vs. 10%, P=0.06).
Rate of a new single-organ or multiple-organ failure was similar in the two groups (P=0.85).
No significant difference in secondary outcomes that included numbers of days spent in the ICU (P=0.44), days spent in the hospital (P=0.30), days of mechanical ventilation (P=0.74), or days of renal-replacement therapy (P=0.41).
Post hoc analysis of trauma subgroup demonstrated a higher mortality with albumin in patients with traumatic brain injury (24.5% vs. 15.1%, P=0.009, NNH 11).
Are there any limitations?
ยท Sub-group analyses had insufficient power.
What does it mean?
There is no difference in 28-day outcome in ICU patients whether 4% albumin or 0.9% sodium chloride was used for fluid resuscitation.
Avoid using albumin in traumatic head injuries.