Small volume resuscitation with 20% albumin in intensive care: physiological effects: The SWIPE randomised clinical trial

PurposeWe set out to assess the resuscitation fluid requirements and physiological and clinical responses of intensive care unit (ICU) patients resuscitated with 20% albumin versus 4-5% albumin.MethodsWe performed a randomised controlled trial in 321 adult patients requiring fluid resuscitation within 48h of admission to three ICUs in Australia and the UK.ResultsThe cumulative volume of resuscitation fluid at 48h (primary outcome) was lower in the 20% albumin group than in the 4-5% albumin group [median difference -600ml, 95% confidence interval (CI) -800 to -400; P<0.001]. The 20% albumin group had lower cumulative fluid balance at 48h (mean difference -576ml, 95% CI -1033 to -119; P=0.01). Peak albumin levels were higher but sodium and chloride levels lower in the 20% albumin group. Median (interquartile range) duration of mechanical ventilation was 12.0h (7.6, 33.1) in the 20% albumin group and 15.3h (7.7, 58.1) in the 4-5% albumin group (P=0.13); the proportion of patients commenced on renal replacement therapy after randomization was 3.3% and 4.2% (P=0.67), respectively, and the proportion discharged alive from ICU was 97.4% and 91.1% (P=0.02).ConclusionsResuscitation with 20% albumin decreased resuscitation fluid requirements, minimized positive early fluid balance and was not associated with any evidence of harm compared with 4-5% albumin. These findings support the safety of further exploration of resuscitation with 20% albumin in larger randomised trials.Trial registrationhttp://www.anzctr.org.au. Identifier ACTRN12615000349549.