Saline or albumin for fluid resuscitation in traumatic brain injury (author reply)

We concur with Jacob and Chappell that the interpretation of our results requires careful consideration, primarily because our study was conducted as a subgroup analysis of the SAFE study.1 However, given the equivalence of injury severity at baseline in the saline group and the albumin group, the similar resuscitation end points achieved under double-blind conditions, and the significant difference in long-term mortality between the two study groups, a reevaluation of purported crystalloid-specific and colloid-specific effects is warranted. Considering the additional cost of albumin, we recommend that saline be used preferentially in patients with traumatic brain injury until fluid strategies with other crystalloids or synthetic colloids have been evaluated under the same rigorous conditions applied in our study.