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SAFE
About the Trial
The Saline versus Albumin Fluid Evaluation trial randomized 6,997 ICU patients to 4 percent albumin or normal saline for fluid resuscitation. Overall 28 day mortality was identical. Subgroup hints, albumin possibly better in sepsis, worse in trauma brain injury, drove later trials. SAFE ended decades of albumin versus crystalloid controversy and dethroned albumin as reflex colloid. It also popularized large pragmatic ICU trials in Australia and New Zealand. CHEST and 6S later showed hydroxyethyl starches harm kidneys and bleeding, completing the demise of synthetic colloids and leaving balanced crystalloids and saline as the everyday resuscitation choices.
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