Sepsis (Sub-Category)

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

S Finfer
R Bellomo
N Boyce
J French
J Myburgh
R Norton
SAFE Study Investigators



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 four 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 6,997 patients who underwent randomization, 3,497 were assigned to receive albumin and 3,500 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 four percent albumin or normal saline for fluid resuscitation results in similar outcomes at 28 days.

PubMed Link to Article:

Finfer S, Bellomo R, Boyce N, French J, Myburgh J, Norton R; SAFE Study Investigators. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med. 2004 May 27;350(22):2247-56. PubMed PMID: 15163774.