The SAFE (Saline versus Albumin Fluid Evaluation) trial compared 0.9% saline versus 4% albumin for ICU resuscitation. Which subgroup showed increased mortality with albumin compared to saline?
- A Patients with traumatic brain injury (TBI) ✓
- B Patients with severe sepsis
- C Patients with burns
- D Patients with ARDS
Correct answer: A. Patients with traumatic brain injury (TBI)
Explanation
The SAFE trial (NEJM 2004) found that albumin and saline were equivalent for most ICU patients. However, a pre-specified subgroup analysis showed that patients with traumatic brain injury (TBI) had higher mortality at 24 months with albumin resuscitation compared to saline. The mechanism is thought to involve albumin-associated reduction in colloid osmotic gradient worsening cerebral edema in patients with disrupted blood-brain barrier. Saline (or hypertonic saline) is therefore preferred in TBI resuscitation.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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