The Saline versus Albumin Fluid Evaluation (SAFE) Study, the largest randomized controlled trial to date, compared 3497 patients who received 4% albumin with 3500 patients receiving normal saline and found no significant difference in mortality,days on the ventilator, need for renal replacement therapy, or hospital length of stay. Subsequent meta-analyses that included the SAFE Study have confirmed overall equivalence in outcomes when comparing albumin with crystalloid for hypovolemic critically ill patients. Given the relative expense and lack of beneficial effects,
albumin as a primary resuscitation fluid cannot be recommended. One should also keep in mind that some patients may be harmed by albumin resuscitation. A subgroup analysis of patients with traumatic brain injury (TBI) in the SAFE Study found that albumin resulted in significantly higher mortality in these patients (RR, 1.63;CI, 1.17–2.26; P 5 .003). This risk was even more pronounced among patients with severe TBI (RR, 1.88; CI, 1.31–2.7; P
The Saline versus Albumin Fluid Evaluation (SAFE) Study, the largest randomized controlled trial to date, compared 3497 patients who received 4% albumin with 3500 patients receiving normal saline and found no significant difference in mortality,days on the ventilator, need for renal replacement therapy, or hospital length of stay. Subsequent meta-analyses that included the SAFE Study have confirmed overall equivalence in outcomes when comparing albumin with crystalloid for hypovolemic critically ill patients. Given the relative expense and lack of beneficial effects,albumin as a primary resuscitation fluid cannot be recommended. One should also keep in mind that some patients may be harmed by albumin resuscitation. A subgroup analysis of patients with traumatic brain injury (TBI) in the SAFE Study found that albumin resulted in significantly higher mortality in these patients (RR, 1.63;CI, 1.17–2.26; P 5 .003). This risk was even more pronounced among patients with severe TBI (RR, 1.88; CI, 1.31–2.7; P<.001).29 Increased mortality associated withalbumin resuscitation has also been noted in trauma and burn patients
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