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Title: Small volume resuscitation with 20% albumin in intensive care: physiological effects : The SWIPE randomised clinical trial.
Austin Authors: Mårtensson, Johan;Bihari, Shailesh;Bannard-Smith, Jonathan;Glassford, Neil J;Lloyd-Donald, Patryck ;Cioccari, Luca;Luethi, Nora;Tanaka, Aiko;Crisman, Marco;Rey de Castro, Nicolas;Ottochian, Marcus;Huang, Agnes;Cronhjort, Maria;Bersten, Andrew D;Prakash, Shivesh;Bailey, Michael;Eastwood, Glenn M ;Bellomo, Rinaldo 
Affiliation: Department of Clinical Science and Education Södersjukhuset, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden
Data Analytics Research and Evaluation (DARE) Centre, Austin Health and The University of Melbourne, Heidelberg, Victoria, Australia
Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, 171 76, Stockholm, Sweden
Department of Anesthesiology and Intensive Care Medicine, Osaka University, Osaka, Japan
Department of Critical Care Medicine, Flinders University, Adelaide, Australia
Austin Health, Heidelberg, Victoria, 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
Department of Intensive and Critical Care Unit, Flinders Medical Centre, Adelaide, Australia
Department of Intensive Care Medicine, University Hospital, University of Bern, Bern, Switzerland
Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
Department of Physiology and Pharmacology, Section of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden
Department of Intensive Care, Manchester Royal Infirmary, Central Manchester University Hospitals, Manchester, UK
Issue Date: Nov-2018 2018-10-21
Publication information: Intensive Care Medicine 2018; 44(11): 1797-1806.
Abstract: 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. 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. 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). 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. . Identifier ACTRN12615000349549.
DOI: 10.1007/s00134-018-5253-2
ORCID: 0000-0001-8739-7896
PubMed URL: 30343313
Type: Journal Article
Subjects: Albumin
Critical care
Fluid therapy
Appears in Collections:Journal articles

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