[ccm-l] SAFE TBI in today's NEJM

[Nick Macartney]

So, Ian, what fluid do you use for fluid challenges in the icu, and why have
you picked it??
Nick Macartney

PS - thanks for the paper. 

> -----Original Message-----
> From: ccm-l-bounces at ccm-l.org 
> [mailto:ccm-l-bounces at ccm-l.org] On Behalf Of Ian Seppelt
> Sent: 30 August 2007 03:34
> To: ccm-l at ccm-l.org; trauma-list at trauma.org
> Subject: [ccm-l] SAFE TBI in today's NEJM
> 
> Today's NEJM has the 2 year followup of the traumatic brain 
> injury cohort from SAFE which clearly shows worse outcomes in 
> the albumin group. Based on this it is reasonable to say that 
> albumin is absolutely contraindicated in TBI, and by 
> extrapolation possibly in ANY trauma [as there is no 
> suggestion of any benefit from albumin in trauma, mild - 
> moderate TBI can be missed acutely in the context of other 
> injuries, plus the cost of albumin].
> 
> The million dollar question is WHY albumin is deleterious. A 
> post hoc analysis of these patients is underway looking at 
> whether there is any subtle difference in baseline (eg 
> differences in ICP or management of intracranial 
> hypertension, etc etc) that might account for it.
> 
> [CAVEAT: I was an investigator in SAFE and am an executive 
> member of the ANZICS CLinical Trials Group. Interpret any 
> implied bias how you will!!!!]
> 
> Cheers, Ian
> 
> Ian Seppelt FANZCA FJFICM
> Senior Staff Specialist
> Dept of Intensive Care Medicine
> The Nepean Hospital, PO Box 63 Penrith NSW 2751 Director of 
> Clinical Research, Sydney West AHS Clinical Lecturer, 
> University of Sydney
>