The SAFE trial (Saline versus Albumin Fluid Evaluation) demonstrated which key finding regarding resuscitation fluids in critically ill patients?

• A 4% albumin was significantly superior to normal saline for 28-day mortality in all critically ill patients
• B Normal saline caused significantly higher rates of hyperchloraemic acidosis leading to increased renal failure
• C Normal saline and 4% albumin had equivalent 28-day mortality overall, but albumin was associated with worse outcomes in the traumatic brain injury subgroup ✓
• D Albumin was superior in septic patients but inferior in post-surgical patients

Explanation

The SAFE trial (NEJM 2004, n=6997) demonstrated no significant difference in 28-day mortality between 4% albumin and normal saline for ICU resuscitation overall (RR 0.99). However, the pre-specified subgroup analysis showed significantly higher mortality with albumin in traumatic brain injury patients (RR 1.63, p=0.009), likely due to albumin entry into injured brain increasing cerebral oedema. Conversely, a trend toward benefit was seen in severe sepsis with albumin. Normal saline causes hyperchloraemic acidosis with large-volume use, but this was not the primary finding of the SAFE trial.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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