A joint study by Australian and New Zealand scientists has revealed vital information for the acute treatment of patients with severe brain injury. The results of the SAFE-TBI study, published recently in the New England Journal of Medicine, show that the choice of resuscitation fluids affects the chances of survival after brain injury. Some patients with brain injury require the administration of fluids to restore blood flow to the brain following trauma. Previously, there has been widespread variation in the types of fluids used. In 2004, reports from the UK, suggesting that albumin-based resuscitation fluids were associated with a higher patient death rate compared with saline, prompted the SAFE study, the largest ever in intensive care. Researchers from the ANZICS CTG, The George Institute for International Health and the Australian Red Cross Blood Service studied 460 people with TBI who were randomly selected to receive either saline or albumin fluid. The results showed very little statistical difference in survival rates over the first 28 days.
However, the SAFE-TBI follow up study reassessed the results after two years and found that patients who received albumin had a 63 per cent higher risk of dying than those given saline. Among patients with severe brain injuries, including those in traumatic coma, the albumin group had an 88 per cent higher risk of death. The implications for acute treatment could be profound and widespread. As study leader Professor John Myburgh said, "It is important for doctors to know that a patient's chances of survival can be substantially improved by the administration of a readily available and inexpensive fluid such as saline."
Reference: The SAFE Study Investigators. (2007). Saline or Albumin for Fluid Resuscitation in Patients with Traumatic Brain Injury, The New England Journal of Medicine, 30th August 2007, 357(9), 874-884.
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