Contents

1 Clinical Question
2 Bottom Line
3 Major Points
4 Guidelines
5 Design
6 Population
6.1 Inclusion Criteria
6.2 Exclusion Criteria
6.3 Baseline Characteristics
7 Interventions
8 Outcomes
8.1 Primary Outcome
8.2 Secondary Outcomes
9 Funding
10 Further Reading

Clinical Question

In ICU patients requiring intravascular volume resuscitation, does the choice of resuscitation fluid (albumin or saline) affect survival?

Bottom Line

In ICU patients requiring fluid resuscitation, there is no significant difference in 28-day mortality rates between those treated with albumin and those treated with saline.

Major Points

Guidelines

Design

Multicenter, double-blind, parallel group, randomized, placebo-controlled trial
N=6,997
Albumin group (n=3,497)
Saline group (n=3,500)

Population

Inclusion Criteria: ICU patients 18 years or older requiring fluid administration to maintain or increase intravascular volume.
Exclusion Criteria: Patients admitted post-cardiac surgery, post-liver transplantation, or for treatment of burns.
Baseline Characteristics: Similar baseline characteristics between both groups, including APACHE II scores and organ failure assessment.

Interventions

Patients were randomized to receive either 4% albumin or normal saline for intravascular fluid resuscitation in the 28 days following randomization.

Outcomes

Primary Outcome: Death from any cause within 28 days of randomization.
Secondary Outcomes: Duration of mechanical ventilation, duration of renal-replacement therapy, length of ICU and hospital stay, rate of new single-organ, and multiple-organ failure.

Funding

Supported by multiple health boards, departments, councils, and CSL (manufacturers of Albumex).

Further Reading

The full text is available from the The New England Journal of Medicine as linked in the original article.