HAS FLAIR-II
Trial question
What is the role of 20% albumin fluid bolus therapy in patients after cardiac surgery?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
21.0% female
79.0% male
N = 466
466 patients (98 female, 368 male).
Inclusion criteria: adult patients in the ICU after cardiac surgery.
Key exclusion criteria: age < 18 years; previous fluid bolus therapy in the ICU after cardiac surgery; known contraindication to the study fluid; imminent death; documented refusal of study fluid.
Interventions
N=233 20% albumin fluid bolus therapy (up to 400 mL of 20% albumin daily, followed by 4% albumin for any additional fluid bolus therapy if needed).
N=233 crystalloid fluid bolus therapy (up to 1,000 mL of crystalloid fluid, followed by 4% albumin for any additional fluid bolus therapy if needed).
Primary outcome
Cumulative median duration of vasopressor therapy
7 hours
10.8 hours
10.8 hours
8.1 hours
5.4 hours
2.7 hours
0.0 hours
20% albumin fluid bolus
therapy
Crystalloid fluid bolus
therapy
No significant
difference ↔
No significant difference in cumulative median duration of vasopressor therapy (7 hours vs. 10.8 hours; AD -3.8 hours, 95% CI -8 to 0.4).
Secondary outcomes
No significant difference in the rate of cumulative proportion of patients receiving any vasopressor therapy by the end of day 7 (72.5% vs. 73%; OR 0.97, 95% CI 0.61 to 1.53).
No significant difference in median duration of ventilation (9.1 hours vs. 7.9 hours; AD 1.2 hours, 95% CI -0.8 to 3.1).
No significant difference in median length of ICU stay (42.5 hours vs. 44.1 hours; AD -1.6 hours, 95% CI -11.9 to 8.7).
Conclusion
In adult patients in the ICU after cardiac surgery, 20% albumin fluid bolus therapy was not superior to crystalloid fluid bolus therapy with respect to cumulative median duration of vasopressor therapy.
Reference
Geoffrey J Wigmore, Adam M Deane, Jeffrey J Presneill et al. Twenty percent human albumin solution fluid bolus administration therapy in patients after cardiac surgery-II: a multicentre randomised controlled trial. Intensive Care Med. 2024 Jul;50(7):1075-1085.
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