ICU resuscitation with either normal saline or 4% albumin results in similar outcomes, in the absence of traumatic brain injury.

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• Simon Finfer, Rinaldo Bellomo, Neil Boyce, Julie French, John Myburgh, Robyn Norton, and SAFE Study Investigators.
• ANZICS CTG, Level 3, 10 Ievers St., Carlton, VIC 3053, Australia. ctg@anzics.com.au
• N. Engl. J. Med.. 2004 May 27;350(22):2247-56.

BackgroundIt remains uncertain whether the choice of resuscitation fluid for patients in intensive care units (ICUs) affects survival. We conducted a multicenter, randomized, double-blind trial to compare the effect of fluid resuscitation with albumin or saline on mortality in a heterogeneous population of patients in the ICU.MethodsWe randomly assigned patients who had been admitted to the ICU to receive either 4 percent albumin or normal saline for intravascular-fluid resuscitation during the next 28 days. The primary outcome measure was death from any cause during the 28-day period after randomization.ResultsOf the 6997 patients who underwent randomization, 3497 were assigned to receive albumin and 3500 to receive saline; the two groups had similar baseline characteristics. There were 726 deaths in the albumin group, as compared with 729 deaths in the saline group (relative risk of death, 0.99; 95 percent confidence interval, 0.91 to 1.09; P=0.87). The proportion of patients with new single-organ and multiple-organ failure was similar in the two groups (P=0.85). There were no significant differences between the groups in the mean (+/-SD) numbers of days spent in the ICU (6.5+/-6.6 in the albumin group and 6.2+/-6.2 in the saline group, P=0.44), days spent in the hospital (15.3+/-9.6 and 15.6+/-9.6, respectively; P=0.30), days of mechanical ventilation (4.5+/-6.1 and 4.3+/-5.7, respectively; P=0.74), or days of renal-replacement therapy (0.5+/-2.3 and 0.4+/-2.0, respectively; P=0.41).ConclusionsIn patients in the ICU, use of either 4 percent albumin or normal saline for fluid resuscitation results in similar outcomes at 28 days.Copyright 2004 Massachusetts Medical Society

This article appears in the collection: Landmark articles in Intensive Care Medicine.

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