The age-old debate about which fluids are best for the resuscitation of patients was thrown into chaos by the meta-analysis published in the BMJ in 1998 by the Cochrane group . This review suggested a 6% increase in mortality for those patients treated with albumin (one additional death for every 17 patients treated).
Much discussion ensued, and further meta-analyses were published, but the major factor lacking was a well-conducted trial to actually answer the question “is albumin safe?”
The Australian and New Zealand Intensive Care Society Clinical Trials Group recently published a definitive study, which comes closer to help us answer this question. This study , published with an editorial3 in the prestigious New England Journal of Medicine in May this year, was a multicenter, randomised, 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. They randomly assigned 6997 patients who had been admitted to the ICU to receive intravascular-fluid resuscitation with either 4 percent albumin or normal saline for the next 28 days.
There were no significant differences between the groups with regard to mortality, numbers of days spent in the ICU, days spent in the hospital, days of mechanical ventilation or days of renal-replacement therapy. Two pre-specified subsets raised some additional interest when albumin administration was associated with better outcomes in one (“severe sepsis”), but was associated with a trend toward worse outcomes in the other (“trauma”). Again, as with many studies, this publication has probably raised more questions than it answered, but it seems that we can at least answer the question “is albumin safe?” Yes!
- Human albumin administration in critically ill patients: systematic review of randomised controlled trials. Cochrane Injuries Group Albumin Reviewers. BMJ 1998;317(7153):235-40.
- Finfer S, Bellomo R, Boyce N, French J, Myburgh J, Norton R, et al. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 2004;350(22):2247-56.
- Cook D. Is albumin safe? N Engl J Med 2004;350(22):2294-6.
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