Erschienen in:
21.10.2018 | Original
Small volume resuscitation with 20% albumin in intensive care: physiological effects
The SWIPE randomised clinical trial
verfasst von:
Johan Mårtensson, Shailesh Bihari, Jonathan Bannard-Smith, Neil J. Glassford, Patryck Lloyd-Donald, Luca Cioccari, Nora Luethi, Aiko Tanaka, Marco Crisman, Nicolas Rey de Castro, Marcus Ottochian, Agnes Huang, Maria Cronhjort, Andrew D. Bersten, Shivesh Prakash, Michael Bailey, Glenn M. Eastwood, Rinaldo Bellomo
Erschienen in:
Intensive Care Medicine
|
Ausgabe 11/2018
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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.