IV Fluids Are Equal, Study Finds

Researchers say saline and albumin are both safe for ICU patients

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By
HealthDay Reporter

WEDNESDAY, May 26, 2004 (HealthDayNews) --For years, clinicians have debated which is the safest fluid for resuscitating critically ill and injured patients: saline or albumin, a component of human blood.

Now, a large study by Australian and New Zealand investigators finds it makes no difference which is used in terms of patient survival.

The risk of dying was no higher among intensive care patients who got albumin than among those who received saline, according to findings published in the May 27 issue of the New England Journal of Medicine.

Said to be the largest study ever attempted in intensive care, the "Saline versus Albumin Fluid Evaluation" (SAFE) findings may help put to rest the medical profession's protracted debate over the safest way to keep critically ill patients' fluids up.

"This means doctors around the world can now reliably use the SAFE study results to guide them when deciding which of these fluids to use in treating their patients," said study author Dr. Simon Finfer, chairman of the Australian and New Zealand Intensive Care Society Clinical Trials Group.

In an accompanying editorial in the journal, Dr. Deborah Cook, an expert in critical care medicine and a professor at McMaster University in Ontario, calls the study a landmark trial and a milestone for the discipline of critical care medicine.

The study was prompted by 1998 research published in the British Medical Journal that suggested albumin caused an increased death rate among critically ill patients. That finding and other conflicting studies only muddied the issue, causing further uncertainty.

To bring some clarity to the debate, investigators recruited almost 7,000 patients who had been admitted to 16 intensive care units (ICUs) in Australia and New Zealand. The patients randomly received either 4 percent albumin or normal saline for fluid resuscitation over the course of 28 days or until they were discharged or died.

In comparing outcomes, researchers found no discernable differences between the two groups: There were 726 deaths in the albumin group, vs. 729 deaths in the saline group.

The proportion of patients who suffered single- or multiple-organ failure was also similar. Plus, researchers found no significant difference in the number of days that patients spent in the ICU.

Two possible caveats: The study provided limited evidence that treatment with saline may be better for patients with brain injuries and that albumin may be the safer choice for patients with severe infections.

The authors said further study is needed to determine whether one fluid or the other is better for special populations of critically ill patients.

So will the study resolve the albumin versus saline debate? Will it change the way that doctors practice?

Cook believes some clinicians will use the study to justify the use of albumin for its overall safety. Others will conclude that routine albumin use is hard to justify without proof of a benefit, since saline is less expensive and results in similar outcomes.

"Saline in cheaper, but individual doctors will weigh up many factors in deciding what to use," Finfer added.

More information

The Society of Critical Care Medicine can tell you about common health problems of critically ill patients.

SOURCES: Simon Finfer, MBBS, MRCP, FRCA, staff specialist, Intensive Therapy Unit, Royal North Shore Hospital, Sydney, Australia, and chairman, Australian and New Zealand Intensive Care Society Clinical Trials Group; May 27, 2004, New England Journal of Medicine

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