SAFE TRIPS

SAFE-TRIPS: Saline versus Albumin Fluid Evaluation Translation of Research Into Practice Study

The SAFE Translation of Research into Practice Study (SAFE-TRIPS) was an international collaboration that assessed worldwide fluid resuscitation practices in the Intensive Care Unit (ICU) and the effect of recent publications (including the Cochrane Review in 1998 and the Saline Albumin Fluid Evaluation [SAFE] study in 2004) on those practices. The collaborative study, conducted in two phases, was coordinated in conjunction with The George Institute for International Health.

Over the last ten years more reliable information regarding the risks and benefits of the use of albumin for fluid resuscitation has emerged. To determine what influence this has had on clinical practice, we sought to document albumin use (from mass of albumin supplied to hospitals) in 16 industrialised countries between 1995 and 2006. The aim of this phase of the study was to describe national albumin use in Australia, New Zealand and internationally as an annual average in the period from January 1996 to December 2005. This period included the publication of the original Cochrane Review (July 1998) and the SAFE study (May 2004).

This second phase of the study was an international cross-sectional observational study to examine fluid resuscitation practice in ICU patients across 24 countries.

Findings: Phase I: Data were obtained from 13 sources covering 15 countries. National data were available for all but one country. Albumin issues varied from 3.92 kg per 10,000 persons in 1995 in Switzerland to 0.43 kg per 10,000 persons in New Zealand in 2005. Overall, aggregate albumin issues in the surveyed countries decreased from a peak of 2.54 kg per 10,000 persons in 1995 to 1.40 kg per 10,000 persons in 1999. Aggregate albumin issues have remained relatively constant since that time varying between 1.35 kg per 10,000 persons in 2004 and 1.51 kg per 10,000 persons in 2000. Hence, the 1998 Cochrane report was followed by a reduction in albumin issues in many of the surveyed countries, and issues have been materially constant since.

Phase II: Over 390 centres from 24 countries registered participated on one of the three nominated data collection days. Data for 5,339 patients have been entered into the study database results will be available soon.

Publications: The publications relating to this study include:

Jones D, McEvoy S, Merz T, Higgins A, Bellomo R, Cooper DJ, Hollis S, McArthur C, Myburgh JA, Taylor C, Liu B, Norton R, Finfer S. International albumin use: 1995 to 2006. Anaesthesia and Intensive Care 2010 38: 266-273.

Collaboration: The SAFE-TRIPS project was conducted in collaboration with the George Institute for International Health.

Endorsement: The SAFE-TRIPS project was endorsed by the ANZICS-CTG.