, Volume 53, Issue 12, pp 1258-1259

Best evidence in critical care medicine

Abstract

Background

Critically ill patients require supplementaryiv fluids to support vital functions. Crystalloids and colloids (naturally-occurring and synthetic) are frequently used for fluid support. The choice of the type of fluid used on mortality among the critically ill remains controversial, as the effect of this choice remains unknown.

Design

Multicentre prospective blinded randomized controlled trial.

Patients

6,997 critically ill patients requiring fluid supplementation because of hemodynamic abnormalities including any of: tachycardia (heart rate > 90), hypotension (systolic pressure < 100 or mean arterial pressure < 75), need for vasoactive medications, oliguria, or delayed capillary refill. The study size had 90% power to detect a 3% difference in mortality between groups.

Intervention

Patients received fluid boluses of either 500 mL of 4% albumin or 0.9% saline, contained in identical opaque glass bottles, until resolution of the hemodynamic abnormality.

Primary endpoint

Mortality, single and multiple organ failures, days of ventilation, days of renal support, days in intensive care, and days in hospital were compared between groups.

Results

No differences were detected between groups in any outcome.

Conclusion

Among the critically ill, outcomes are no different when comparing 4% albumin and normal saline for fluid resuscitation to treatment hemodynamic abnormalities.