…or, at least, that’s the gist of the New England Journal Article making rounds in the news.
And, while a close reading of the article doesn’t offer great support for harm, it certainly supports saying that albumin, saline, or nothing were equivalent.
The absolute difference in survival was 3% – and, looking at the demographic breakdown, there were 2-3% differences or trends in favor of the control group regarding dehydration, acidemia, base-deficit, and bacteremia. Enough that it lets me cling in denial to standard practice and teaching here in the U.S., in addition to whatever you want to say about external validity of a study in resource-poor settings in Africa.
It is an odd and unexpected finding, so say the least. The authors attribute at least part of the unusual discovery to the high percentage of malaria cases they treated, and that fluid resuscitation in malaria is controversial – but regardless, this is going to be a frequently discussed study on the Pediatric Critical Care side of things for some time. I also expect follow-up confirmatory studies to be a tough sell to U.S. IRBs.