Critical Illness: SAFE (2004 Saline versus Albumin Fluid Evaluation

Question 1

SAFE Clinical Q

Answer 1

Among ICU patients, does albumin compared to normal saline for fluid resuscitation improve clinical outcomes?

Question 2

SAFE Bottom Line

Answer 2

Albumin and normal saline result in similar clinical outcomes when administered to ICU patients for volume resuscitation, except for those with traumatic brain injury who do worse with albumin.

Question 3

SAFE Primary Outcome

Answer 3

All-cause mortality at 28 days

Question 4

SAFE inclusion Criteria

Answer 4

-ICU patients -Age ≥18 years -Requiring IV fluids as assessed by treating physician

Question 5

SAFE interventions

Answer 5

• Randomized to receive either 4% albumin or normal saline for fluid resuscitation
  
  • Participants were stratified by institution and diagnosis of trauma
• Continuation of administration of fluid resuscitation until death, discharge, or for a total of 28 days
  
  • Patients continued to receive other fluids (including maintenance, blood products, TPN, enteral feedings) as seen fit by clinicians

Question 6

SAFE criticisms

Answer 6

• Not powered sufficiently to detect small differences in the subgroups
• Death at 28 days may not be the most appropriate outcome measure for patients with brain injury