Canadian Journal of Anesthesia

, Volume 53, Issue 12, pp 1258–1259 | Cite as

Best evidence in critical care medicine

Fluid resuscitation among the critically ill: more water under the bridge
  • Michael J. Jacka
  • Dario Alberton
  • R. T. Noel Gibney
Neuroanesthesia and Intensive Care



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.


Multicentre prospective blinded randomized controlled trial.


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.


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.


No differences were detected between groups in any outcome.


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


Trauma Patient Fluid Resuscitation Fluid Bolus Capillary Refill Fluid Supplementation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    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; 350: 2247–56.PubMedCrossRefGoogle Scholar
  2. 2.
    Anonymous. Human albumin administration in critically ill patients: systematic review of randomised controlled trials. Cochrane Injuries Group Albumin Reviewers. BMJ 1998; 317: 235–40.Google Scholar
  3. 3.
    Choi PT, Yip G, Quinonez LG, Cook DJ. Crystalloids vs. colloids in fluid resuscitation: a systematic review. Crit Care Med 1999; 27: 200–10.PubMedCrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists 2006

Authors and Affiliations

  • Michael J. Jacka
    • 1
  • Dario Alberton
    • 1
  • R. T. Noel Gibney
    • 1
  1. 1.University of AlbertaEdmontonCanada

Personalised recommendations