Balancing benefits and harms in health care: New trial on albumin and saline should have been considered

doi:10.1136/bmj.329.7463.457-c

BMJ 2004;329:457-458 (21 August), doi:10.1136/bmj.329.7463.457-c

Letter

Balancing benefits and harms in health care

New trial on albumin and saline should have been considered

The first 150 words of the full text of this article appear below.

EDITOR—Balancing the benefits and harms of interventionsrequires accurate, up to date information. Therefore, it wasunfortunate that Cuervo and Aronson chose albumin for resuscitationof the critically ill as an example of an intervention whichturned out to be harmful.¹

They say that, on the basis of the Cochrane review of the subject,²albumin for resuscitating critically ill patients with hypovolaemia,burns, or hypoalbuminaemia probably worsens outcomes. This evidencehas been superseded by the results of a recent high qualityrandomised controlled trial.

The saline versus albumin for fluid resuscitation (SAFE) study³enrolled 6997 patients (50 times the number of patients in thelargest trial included in the Cochrane review) to answer thequestion of whether albumin is safe in the resuscitation ofthe critically ill. No difference was seen in 28 day mortalitybetween patients resuscitated with 0.9% saline or albumin (relativerisk 0.99; 95% confidence . . . [Full text of this article]

Stephen M Drage, specialist registrar in anaesthesia and intensive care

John Radcliffe Hospital, Oxford OX3 9DU steve.drage@tiscali.co.uk