SAFE TBI in today's NEJM

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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
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