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Time To End the Crystalloid vs. Colloid Debate
Results of a large, randomized, double-blind study show that there is no evidence to support the use of colloid over crystalloid for volume resuscitation.
The debate over whether to use crystalloid or colloid for fluid resuscitation in critically ill patients seems to have begun at the dawn of medical time. Although many studies have been performed, methodologic flaws (e.g., underpowered, not blinded) limit interpretation of their findings, and two meta-analyses have yielded different conclusions. Investigators in Australia and New Zealand conducted the randomized double-blind SAFE (Saline versus Albumin Fluid Evaluation) study to test the hypothesis that rates of death from any cause within 28 days do not differ, whether patients are treated with 4% albumin or normal saline. Patients who had cardiac surgery or liver transplantation and those with burns were excluded. Investigators used specially manufactured containers and tubing to ensure blinding.
Nearly 7000 patients in 16 intensive care units who required fluid resuscitation received either 4% albumin or normal saline. Other aspects of care were not controlled. The absolute difference in rates of death from any cause within 28 days was 0.2%; the relative risk for death in the albumin group was 0.99. Mean length of stay in the ICU and in the hospital, and number of days of mechanical ventilation, did not differ between groups. Patients in the albumin group received a significantly greater mean volume of blood during the first two days than did those in the saline group.
Comment: These results show that albumin and saline are clinically equivalent. Cost and safety now can be brought into the discussion of which type of fluid is best. In practice, saline seems to already be the winner. The real effect of this study, then, will be to spare us all one more lecture on the crystalloid versus colloid debate.
— J. Stephen Bohan, MS, MD, FACP, FACEP
Published in Journal Watch Emergency Medicine June 16, 2004
Citation(s):
The SAFE Study Investigators. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 2004 May 27; 350:2247-56.
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