Fluid Resuscitation in the Intensive Care Unit

To the Editor: The Saline versus Albumin Fluid Evaluation (SAFE) Study (May 27 issue) 1 debunks a 1998 meta-analysis associating albumin with increased mortality in critical care populations. 2 Regrettably, this trial may spawn a new misconception: that albumin and saline are equivalent for resuscitating a heterogeneous mix of patients in intensive care units. Patients with trauma are generally young and healthy and should not be grouped for evaluation with older patients without trauma, many of whom have preexisting cardiopulmonary disease. The incidence of pulmonary edema is low in patients with hemorrhagic trauma, and studies have not demonstrated a benefit of albumin . . .