World's largest study into intensive care

The University of Sydney has played a part in the world's largest study into intensive care, which contains significant findings for doctors all over the world.

The University-affiliated George Institute for International Health has been part of a study which cleared away doubts about the safety of albumin, a product widely used to keep up the fluids of critically ill patients, particularly in Australia and New Zealand.

The results of the SAFE study (Saline versus Albumin Fluid Evaluation), published in the New England Journal of Medicine, show there is no discernible difference in death rates in intensive care patients resuscitated with either human albumin or saline.

This debunks a previous study, the Cochrane Review, published around six years ago in the British Medical Journal, which suggested that albumin - a protein extracted from donated plasma - caused an increase in mortality rates.

"We spent 18 months recruiting almost 7000 patients in 16 intensive care units in Australia and New Zealand to answer a question that has hung over the medical community for six years," said Professor Robyn Norton, a principal director of the George Institute and Professor of Public Health. "After the results of the Cochrane Review were published, clinicians across the world were uncertain about the safety of albumin, and needed the high-quality evidence from the SAFE study to guide them in their decision-making."

The George Institute was invited to be part of the study by the two other collaborators, the Australian and New Zealand Intensive Care Society Clinical Trials Group and the Australian Red Cross Blood Service, because of its experience in conducting large trials using the web.

The collaboration has been so successful that the New England Journal of Medicine, which is publishing the results, called the study "a milestone for the discipline of critical care medicine". The publishers also noted the use of interdisciplinary implementation strategies and web-based management.

"We have provided doctors with vastly superior evidence to any they have had in the past," said Professor Norton. "They can now make well-informed, evidence-based decisions about which form of fluid resuscitation they use for critically ill patients."

The George Institute and its partners are currently working on their next project, which looks at insulin control in patients in intensive care.

"It is nice to see that an increasing number of people in the intensive care community are recognising the work we have been doing," said Professor Norton. "More than 100,000 people in Australia and New Zealand, and millions worldwide, are admitted to ICUs every year, so the potential is there for results of studies such as SAFE to really make a difference."

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