A comparison of albumin and saline for fluid resuscitation in the intensive care unit.
BACKGROUND
It 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.


METHODS
We 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.


RESULTS
Of 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).


CONCLUSIONS
In patients in the ICU, use of either 4 percent albumin or normal saline for fluid resuscitation results in similar outcomes at 28 days.
Finfer
Simon
S
ANZICS CTG, Level 3, 10 Ievers St., Carlton, VIC 3053, Australia. ctg@anzics.com.au
Bellomo
Rinaldo
R
Boyce
Neil
N
French
Julie
J
Myburgh
John
J
Norton
Robyn
R
D000328:Adult; D000418:Albumins / Q000627:therapeutic use*; D001794:Blood Pressure; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D004311:Double-Blind Method; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006339:Heart Rate; D006801:Humans; D020896:Hypovolemia / Q000503:physiopathology / Q000628:therapy*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000453:epidemiology; D012306:Risk; D012965:Sodium Chloride / Q000627:therapeutic use*; D016019:Survival Analysis; D016896:Treatment Outcome
D000418:Albumins; D012965:Sodium Chloride