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Commentary

Albumin in critical care: SAFE, but worth its salt?

Eddy Fan1 and Thomas E Stewart2*

Author Affiliations

1 Medical Resident, Department of Medicine, University of Toronto, Ontario, Canada

2 Director, Critical Care Units, Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada, and Associate Professor, Department of Anesthesia and Department of Medicine, University of Toronto, Ontario, Canada

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Critical Care 2004, 8:297-299  doi:10.1186/cc2943

Published: 20 August 2004

Abstract

Intravascular fluid therapy is a common critical care intervention. However, the optimal type of resuscitation fluid, crystalloid or colloid, remains controversial. Despite the many theoretical benefits of human albumin administration in critically ill patients, there has been little evidence to support its widespread clinical use. Previous systematic reviews have led to conflicting results regarding the safety and efficacy of albumin. The recently reported Saline versus Albumin Evaluation study has provided conclusive evidence that 4% albumin is as safe as saline for resuscitation, although no overall benefit of albumin use was seen. Subgroup analysis of the albumin-treated group revealed a trend towards decreased mortality in patients with septic shock, and a trend towards increased mortality in trauma patients, especially those with traumatic brain injury. The results of these subgroups, as well as the use of higher albumin concentrations and other synthetic colloids (dextrans, starches), require rigorous evaluation in clinical trials. Finally, the Saline versus Albumin Evaluation trial represents a methodological milestone in critical care medicine, due to its size, its efficient trial design, and its logistical coordination. Future studies are still required, however, to establish a therapeutic niche for albumin and other colloids.

Keywords:
albumins; colloids; critical care; crystalloids; fluid therapy