Commentary by Dr. Paul McCarthy of East Carolina University Division of Critical Care
I agree that most of the data regarding over-resuscitation is kind of new, especially things like death, but there is a lot a data showing think like LOS, Vent days, need for trach, costs, etc. that have been out there a long time.
Also the data about chloride rich fluids has been out there for some time, although big RCT are not plenty.
As for the SAFE trial, this was done by Rinaldo Bellomo to see if albumin was as “safe” as NS. What was used in this study was NS vs. 4% album (96% NS). 4% albumin in not available in USA and I agree with Dr. Shaw that maybe they are just as bad. From this study they are equal. Things to note about the study: The patient population was not too sick by ICU standards (low APACHE scores, very “stable” vital signs, very low deaths and low LOS), Also the subgroups of sepsis and severe sepsis actually did better with the 4%albumin/96%NS. The patients with TBI did worse with 4% albumin/96%NS (however this group also had more hyponatremia, a major factor associated with poor outcomes in brain injury)
The FEAST trial showed worse outcomes in those that got fluid bolus of NS or 4%albumin/96% NS vs bolus in all comers, except severe sepsis. Maybe in the not septic patients NS or 4%album/NS is just as good (or bad), however, it has been argued that the whole concept of the “bolus” is bad. There is not data showing a fluid bolus helps outcomes.