Best evidence in critical care medicine: Fluid resuscitation among the critically ill: more water under the bridge.

摘要

Background: Critically ill patients require supplementary iv fluids to support vital functions. Crystalloids and colloids (naturally-occurring and synthetic) are frequently used for fluid support. The choice of the type of fluid used on mortality among the critically ill remains controversial, as the effect of this choice remains unknown.Design: Multicentre prospective blinded randomized controlled trial.Patients: 6,997 critically ill patients requiring fluid supplementation because of hemodynamic abnormalities including any of: tachycardia (heart rate > 90), hypotension (systolic pressure < 100 or mean arterial pressure < 75), need for vasoactive medications, oliguria,or delayed capillary refill. The study size had 90% power to detect a 3% difference in mortality between groups.Intervention: Patients received fluid boluses of either 500 mL of 4% albumin or 0.9% saline, contained in identical opaque glass bottles, until resolution of the hemodynamic abnormality.Primary endpoint: Mortality, single and multiple organ failures, days of ventilation, days of renal support, days in intensive care, and days in hospital were compared between groups.Results: No differences were detected between groups in any outcome.Conclusion: Among the critically ill, outcomes are no different when comparing 4% albumin and normal saline for fluid resuscitation to treatment hemodynamic abnormalities.