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!