Guidelines for Complications of Cancer Treatment Vol VIII Part B

in survival of 7.6%. By the second hour after onset ofpersistent/recurrent hypotension, in-hospital mortality rate wassignificantly increased relative to receiving therapy within thefirst hour (odds ratio 1.67; 95% confidence interval, 1.12-2.48). In multivariate analysis (including Acute Physiologyand Chronic Health Evaluation II score and therapeuticvariables), time to initiation of effective antimicrobial therapywas the single strongest predictor of outcome. Median time toeffective antimicrobial therapy was 6 hrs (25-75th percentile,2.0-15.0 hrs). CONCLUSIONS: Effective antimicrobialadministration within the first hour of documented hypotensionwas associated with increased survival to hospital dischargein adult patients with septic shock. Despite a progressiveincrease in mortality rate with increasing delays, only 50% ofseptic shock patients received effective antimicrobial therapywithin 6 hrs of documented hypotension.PMID: 16625125 [PubMed - indexed for MEDLINE]Finfer S, Bellomo R, Boyce N, et al for SAFE StudyInvestigators. A comparison of albumin and saline forfluid resuscitation in the intensive care unit. N Engl JMed. 2004; 350: 2247-56.BACKGROUND: It remains uncertain whether the choice ofresuscitation fluid for patients in intensive care units (ICUs)affects survival. We conducted a multicenter, randomized,double-blind trial to compare the effect of fluid resuscitationwith albumin or saline on mortality in a heterogeneouspopulation of patients in the ICU. METHODS: We randomlyassigned patients who had been admitted to the ICU to receiveeither 4 percent albumin or normal saline for intravascularfluidresuscitation during the next 28 days. The primaryoutcome measure was death from any cause during the 28-day period after randomization. RESULTS: Of the 6997patients who underwent randomization, 3497 were assignedto receive albumin and 3500 to receive saline; the two groups91