The SAFE (Saline versus Albumin Fluid Evaluation) study demonstrated that in critically ill patients requiring fluid resuscitation, albumin solution compared to normal saline was associated with:

• A Significantly lower 28-day mortality overall
• B Significantly lower rates of acute kidney injury
• C Lower incidence of ARDS and pulmonary complications
• D Similar 28-day mortality overall but harm in traumatic brain injury subgroup ✓

Explanation

The SAFE trial (NEJM 2004) found no significant difference in 28-day mortality between 4% albumin and normal saline for ICU resuscitation overall. However, subgroup analysis showed a trend toward higher mortality with albumin in traumatic brain injury patients (RR 1.63), likely due to albumin entering the injured blood-brain barrier and worsening cerebral oedema. This has led to absolute avoidance of albumin in TBI. In severe sepsis, albumin may have modest benefit. The study established that both fluids are broadly equivalent in most ICU settings.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.