Johan Mårtensson1,2,3, Shailesh Bihari4,5, Jonathan Bannard-Smith6, Neil J Glassford7, Patryck Lloyd-Donald7, Luca Cioccari7,8, Nora Luethi7, Aiko Tanaka7,9, Marco Crisman7, Nicolas Rey de Castro6, Marcus Ottochian7, Agnes Huang7, Maria Cronhjort7,10, Andrew D Bersten4,5, Shivesh Prakash4,5, Michael Bailey11,12, Glenn M Eastwood7, Rinaldo Bellomo7,13,11,12,14. 1. Department of Intensive Care, Austin Hospital, Melbourne, Australia. johan.martensson@sll.se. 2. Department of Physiology and Pharmacology, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden. johan.martensson@sll.se. 3. Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, 171 76, Stockholm, Sweden. johan.martensson@sll.se. 4. Department of Intensive and Critical Care Unit, Flinders Medical Centre, Adelaide, Australia. 5. Department of Critical Care Medicine, Flinders University, Adelaide, Australia. 6. Department of Intensive Care, Manchester Royal Infirmary, Central Manchester University Hospitals, Manchester, UK. 7. Department of Intensive Care, Austin Hospital, Melbourne, Australia. 8. Department of Intensive Care Medicine, University Hospital, University of Bern, Bern, Switzerland. 9. Department of Anesthesiology and Intensive Care Medicine, Osaka University, Osaka, Japan. 10. Department of Clinical Science and Education Södersjukhuset, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden. 11. Australian and New Zealand Intensive Care Research Centre, Monash University School of Public Health and Preventive Medicine, Melbourne, Australia. 12. School of Medicine, The University of Melbourne, Melbourne, Australia. 13. Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia. 14. Data Analytics, Research and Evaluation (DARE) Centre, University of Melbourne and Austin Hospital, Melbourne, Australia.
Abstract
PURPOSE: We set out to assess the resuscitation fluid requirements and physiological and clinical responses of intensive care unit (ICU) patients resuscitated with 20% albumin versus 4-5% albumin. METHODS: We performed a randomised controlled trial in 321 adult patients requiring fluid resuscitation within 48 h of admission to three ICUs in Australia and the UK. RESULTS: The cumulative volume of resuscitation fluid at 48 h (primary outcome) was lower in the 20% albumin group than in the 4-5% albumin group [median difference - 600 ml, 95% confidence interval (CI) - 800 to - 400; P < 0.001]. The 20% albumin group had lower cumulative fluid balance at 48 h (mean difference - 576 ml, 95% CI - 1033 to - 119; P = 0.01). Peak albumin levels were higher but sodium and chloride levels lower in the 20% albumin group. Median (interquartile range) duration of mechanical ventilation was 12.0 h (7.6, 33.1) in the 20% albumin group and 15.3 h (7.7, 58.1) in the 4-5% albumin group (P = 0.13); the proportion of patients commenced on renal replacement therapy after randomization was 3.3% and 4.2% (P = 0.67), respectively, and the proportion discharged alive from ICU was 97.4% and 91.1% (P = 0.02). CONCLUSIONS: Resuscitation with 20% albumin decreased resuscitation fluid requirements, minimized positive early fluid balance and was not associated with any evidence of harm compared with 4-5% albumin. These findings support the safety of further exploration of resuscitation with 20% albumin in larger randomised trials. TRIAL REGISTRATION: http://www.anzctr.org.au . Identifier ACTRN12615000349549.
RCT Entities:
PURPOSE: We set out to assess the resuscitation fluid requirements and physiological and clinical responses of intensive care unit (ICU) patients resuscitated with 20% albumin versus 4-5% albumin. METHODS: We performed a randomised controlled trial in 321 adult patients requiring fluid resuscitation within 48 h of admission to three ICUs in Australia and the UK. RESULTS: The cumulative volume of resuscitation fluid at 48 h (primary outcome) was lower in the 20% albumin group than in the 4-5% albumin group [median difference - 600 ml, 95% confidence interval (CI) - 800 to - 400; P < 0.001]. The 20% albumin group had lower cumulative fluid balance at 48 h (mean difference - 576 ml, 95% CI - 1033 to - 119; P = 0.01). Peak albumin levels were higher but sodium and chloride levels lower in the 20% albumin group. Median (interquartile range) duration of mechanical ventilation was 12.0 h (7.6, 33.1) in the 20% albumin group and 15.3 h (7.7, 58.1) in the 4-5% albumin group (P = 0.13); the proportion of patients commenced on renal replacement therapy after randomization was 3.3% and 4.2% (P = 0.67), respectively, and the proportion discharged alive from ICU was 97.4% and 91.1% (P = 0.02). CONCLUSIONS: Resuscitation with 20% albumin decreased resuscitation fluid requirements, minimized positive early fluid balance and was not associated with any evidence of harm compared with 4-5% albumin. These findings support the safety of further exploration of resuscitation with 20% albumin in larger randomised trials. TRIAL REGISTRATION: http://www.anzctr.org.au . Identifier ACTRN12615000349549.
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