Science-based fluid therapy in the intensive care unit: Professor Rinaldo Bellomo’s legacy

Abstract

Research into the use of resuscitation and “maintenance” fluids in the intensive care unit was integral to the development of the Australian and New Zealand Intensive Care Society Clinical Trials Group (CTG) and the CTG being recognised as one of the most productive and influential trials groups in the world. Professor Rinaldo Bellomo (Rinaldo) played a central and critical role in this research and in this article; we focus on Rinaldo’s many roles and contributions to the key large clinical trials that changed the critical care research landscape in Australia and New Zealand and clinical practice worldwide. With a proposed recruitment of 7000 participants, the Saline versus Albumin Fluid Evaluation study was the first large pragmatic trial conducted in intensive care units anywhere in the world. Rinaldo brought the concept of the trial to the CTG and was critical to securing funding from multiple sources at a time when Australian National Health and Medical Research Council’s funding limits would cover only a fraction of the costs of such a trial. His personal contacts at CSL Ltd. and the Australian Red Cross Blood Service helped secure the supply of study fluids and made possible the seemingly impossible task of blinding a trial of two fluids that were macroscopically different with one supplied in glass bottles and the other in polyvinyl chloride bags. The successful conduct of the Saline versus Albumin Fluid Evaluation trial, the CTG’s first publication in The New England Journal of Medicine and presentation at the US Food and Drugs Administration, established the CTG on the global stage and served as a template for the Crystalloid versus Hydroxyethyl Starch Study and PlasmaLyte-148® versus Saline Study trials; we can only speculate what fraction of this could have been achieved without Rinaldo.