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.
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References
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Choi PT, Yip G, Quinonez LG, Cook DJ. Crystalloids vs. colloids in fluid resuscitation: a systematic review. Crit Care Med 1999; 27: 200–10.
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Jacka, M.J., Alberton, D. & Noel Gibney, R.T. Best evidence in critical care medicine. Can J Anesth 53, 1258–1259 (2006). https://doi.org/10.1007/BF03021587
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DOI: https://doi.org/10.1007/BF03021587