CRS Journal Reading

R1 / Chiang Kuan Yu

Severe Sepsis

Colloid or Crystalloid?

First DO NO HARM.

the Saline versus Albumin Fluid Evaluation [SAFE]

study

Method

Multicenter ICU in Italy

1818 patients with severe sepsis

Randomization

6 excluded owing to error

Open-label trial

2 withdrawal of consent

Subgroups

Crystalloid group

Albumin group

maintain serum albumin > 30 g/L

until day 28 or ICU discharge

synthetic colloids was not allowed

Outcome

The primary outcome

Death from any cause at 28 days

The Secondary outcomes

Death from any cause at 90 days

organ dysfunction

degree of dysfunction

Sequential Organ Failure Assessment (SOFA) score

length of ICU / hospital.

Outcome

Outcome

Comment

No significant difference in survival

The albumin group :

lower cardiovascular score (P = 0.03)

higher coagulation score (P = 0.04)

higher liver score (P = 0.02)

time of vasopressor / inotropic agents was shorter (P =

0.007)

Discussion

Albumin

Oncotic pressure

Intravascular volume

Greater proportion to the targeted mean BP

Scavenger of nitric oxide

mediating peripheral vasodilatation during sepsis

Good for hemodynamic variable

Discussion

SOFA subscores : Detailed profile of the safety

Liver higher serum bilirubin

inefficient in clearing bilirubin

Coagulation a lower platelet count

marker of a larger expansion of the intravascular

Conclusion

In patients with severe sepsis, albumin replacement

in addition to crystalloids, as compared with

crystalloids alone, did not improve the rate of

survival

The end!