The ATBF (Albumin, Blood, Fluid) algorithm for colloid versus crystalloid resuscitation has been largely supplanted by evidence. The SAFE trial (2004) comparing albumin versus saline in ICU patients found that albumin was associated with increased mortality in which specific patient subgroup?

• A Septic shock patients — albumin increased 28-day mortality
• B Post-operative cardiac surgery patients — albumin caused renal failure
• C Burn patients — albumin increased pulmonary oedema risk
• D Traumatic brain injury (TBI) patients — albumin was associated with higher mortality ✓

Explanation

The SAFE (Saline versus Albumin Fluid Evaluation) trial (NEJM 2004) found that overall, albumin and saline were equivalent for fluid resuscitation in ICU patients. However, in the pre-specified subgroup analysis, traumatic brain injury patients who received albumin had significantly higher 2-year mortality compared to those receiving saline, likely due to the effect of albumin on intracranial pressure dynamics. In septic shock, albumin was actually associated with a trend toward benefit. The ALBIOS trial subsequently confirmed albumin-targeted resuscitation in sepsis has no mortality benefit but may reduce fluid administration.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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