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. doi: 10.1056/NEJMoa040232.

Abstract

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 4 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 6997 patients who underwent randomization, 3497 were assigned to receive albumin and 3500 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 4 percent albumin or normal saline for fluid resuscitation results in similar outcomes at 28 days.

Publication types

  • Clinical Trial
  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Albumins / therapeutic use*
  • Blood Pressure
  • Critical Illness / mortality
  • Critical Illness / therapy*
  • Double-Blind Method
  • Female
  • Fluid Therapy / methods*
  • Heart Rate
  • Humans
  • Hypovolemia / physiopathology
  • Hypovolemia / therapy*
  • Intensive Care Units
  • Male
  • Middle Aged
  • Multiple Organ Failure / epidemiology
  • Risk
  • Sodium Chloride / therapeutic use*
  • Survival Analysis
  • Treatment Outcome

Substances

  • Albumins
  • Sodium Chloride