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Small volume resuscitation with 20% albumin in intensive care: physiological effects : The SWIPE randomised clinical trial

Department of Intensive Care, Austin Hospital, Melbourne, Australia. johan.martensson@sll.se. Department of Physiology and Pharmacology, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden. johan.martensson@sll.se. Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, 171 76, Stockholm, Sweden. johan.martensson@sll.se. Department of Intensive and Critical Care Unit, Flinders Medical Centre, Adelaide, Australia. Department of Critical Care Medicine, Flinders University, Adelaide, Australia. Department of Intensive Care, Manchester Royal Infirmary, Central Manchester University Hospitals, Manchester, UK. Department of Intensive Care, Austin Hospital, Melbourne, Australia. Department of Intensive Care, Austin Hospital, Melbourne, Australia. Department of Intensive Care, Austin Hospital, Melbourne, Australia. Department of Intensive Care Medicine, University Hospital, University of Bern, Bern, Switzerland. Department of Intensive Care, Austin Hospital, Melbourne, Australia. Department of Intensive Care, Austin Hospital, Melbourne, Australia. Department of Anesthesiology and Intensive Care Medicine, Osaka University, Osaka, Japan. Department of Intensive Care, Austin Hospital, Melbourne, Australia. Department of Intensive Care, Manchester Royal Infirmary, Central Manchester University Hospitals, Manchester, UK. Department of Intensive Care, Austin Hospital, Melbourne, Australia. Department of Intensive Care, Austin Hospital, Melbourne, Australia. Department of Intensive Care, Austin Hospital, Melbourne, Australia. Department of Clinical Science and Education Sodersjukhuset, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden. Department of Intensive and Critical Care Unit, Flinders Medical Centre, Adelaide, Australia. Department of Critical Care Medicine, Flinders University, Adelaide, Australia. Department of Intensive and Critical Care Unit, Flinders Medical Centre, Adelaide, Australia. Department of Critical Care Medicine, Flinders University, Adelaide, Australia. Australian and New Zealand Intensive Care Research Centre, Monash University School of Public Health and Preventive Medicine, Melbourne, Australia. School of Medicine, The University of Melbourne, Melbourne, Australia. Department of Intensive Care, Austin Hospital, Melbourne, Australia. Department of Intensive Care, Austin Hospital, Melbourne, Australia. Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia. Australian and New Zealand Intensive Care Research Centre, Monash University School of Public Health and Preventive Medicine, Melbourne, Australia. School of Medicine, The University of Melbourne, Melbourne, Australia. Data Analytics, Research and Evaluation (DARE) Centre, University of Melbourne and Austin Hospital, Melbourne, Australia.

Intensive Care Medicine. 2018;44((11):):1797-1806.
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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. TRIAL REGISTRATION http://www.anzctr.org.au . Identifier ACTRN12615000349549.
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Language : English
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine