The SAFE study compared albumin versus normal saline resuscitation in ICU patients. Which finding was specific to the traumatic brain injury subgroup?

• A Albumin resuscitation was associated with significantly higher 2-year mortality in TBI patients ✓
• B Albumin resuscitation significantly improved mortality in TBI patients
• C Normal saline was associated with significantly higher mortality in TBI patients
• D No difference was found in the TBI subgroup

Explanation

The SAFE study post-hoc analysis demonstrated that albumin resuscitation was associated with significantly higher 2-year mortality in patients with severe traumatic brain injury compared to saline, despite equivalent overall ICU outcomes in the general population. The proposed mechanism is that albumin, being a colloid, may expand the intravascular compartment but also increases edema across a disrupted blood-brain barrier, worsening intracranial pressure. Consequently, albumin is contraindicated for fluid resuscitation in TBI.

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

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