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

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 (2018). Small volume resuscitation with 20% albumin in intensive care: physiological effects : The SWIPE randomised clinical trial. Intensive care medicine, 44(11), pp. 1797-1806. Springer-Verlag 10.1007/s00134-018-5253-2

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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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