***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Objective To determine whether outcomes of resuscitation with albumin or saline in the intensive care unit depend on patients ' baseline serum albumin concentration . Design Analysis of data from a double blind , r and omised controlled trial . Setting Intensive care units of 16 hospitals in Australia and New Zeal and . Participants 6045 participants in the saline versus albumin fluid evaluation ( SAFE ) study . Interventions Fluid resuscitation with 4 % albumin or saline in  patients with a baseline serum albumin concentration of 25 g/l or less or more than 25 g/l . Main outcome measures Primary outcome was all cause mortality at 28 days . Secondary outcomes were length of stay in the intensive care unit , length of stay in hospital , duration of renal replacement therapy , and duration of mechanical ventilation . Main results The odds ratios for death for albumin compared with saline for patients with a baseline serum albumin concentration of 25 g/l or less and more than 25 g/l were 0.87 and 1.09 , respectively ( ratio of odds ratios 0.80 , 95 % confidence interval 0.63 to 1.02 ) ; P=0.08 for heterogeneity . No significant interaction was found between baseline serum albumin concentration as a continuous variable and the effect of albumin and saline on mortality . No consistent interaction was found between baseline serum albumin concentration and treatment effects on length of stay in the intensive care unit , length of hospital stay , duration of renal replacement therapy , or duration of mechanical ventilation . Conclusion The outcomes of resuscitation with albumin and saline are similar irrespective of patients ' baseline serum albumin concentration . Trial registration IS RCT N76588266 Objective Both albumin and synthetic colloids such as hydroxyethyl starch ( HES ) solution are used to optimize hemodynamics in the critically ill . The influence of different long-term infusion regimes on platelet function was studied . Design Prospect i ve , r and omized study . Setting Clinical investigation on a university hospital surgical intensive care unit . Patients Twenty-eight consecutive trauma patients ( injury severity score>15 points ) and 28 consecutive nontraumatized surgical patients with sepsis . Interventions The patients received either 20 % human albumin ( HA trauma , n=14 ; HA sepsis , n=14 ) or 10 % low-molecular-weight HES solution HES 200/0.5 ( HES trauma , n=14 ; HES sepsis;n=14 ) for 5 days to maintain central venous pressure and /or pulmonary capillary wedge pressure between 12 and 16 mmHg . Measurements and results Platelet function was assessed by aggregometry ( = turbidimetric technique ) using adenosine diphosphate 2.0 μmol/l , collagen 4 μl/ml , and epinephrine 25 μmol/l as inductors . Arterial blood was sample d on the day of admission or the day of diagnosis of sepsis ( = baseline value ) and over the next 5 days . St and ard coagulation parameters ( antithrombin III , fibrinogen , partial thromboplastin time ) were also measured . Total use of HES by the 5th day totalled 4870±990 ml in the trauma and 3260±790 ml in the sepsis patients ( HA trauma : 1850±380 ml ; HA sepsis : 1790±400 ml ) . Maximum platelet aggregation decreased significantly during the first 2–3 days after baseline in all groups . At the end of the investigation period , platelet aggregation variables had recovered and reached ( or even exceeded ) baseline values . Within the entire investigation period , the course of platelet aggregation variables did not differ significantly between HA and HES-treated patients irrespective of whether they were trauma or sepsis patients . Conclusions Alterations in hemostasis may occur for several reasons in the critically ill . Human albumin is the preferred first-line volume therapy in patients at risk for coagulation disorders . With respect to platelet function , volume replacement with ( lower-priced ) low-molecular-weight HES solutions can be recommended in this situation without any risk BACKGROUND It remains uncertain whether the choice of resuscitation fluid for patients in intensive care units ( ICUs ) affects survival . We conducted a multicenter , r and omized , double-blind trial to compare the effect of fluid resuscitation with albumin or saline on mortality in a heterogeneous population of patients in the ICU . METHODS We r and omly assigned patients who had been admitted to the ICU to receive either 4 percent albumin or normal saline for intravascular-fluid resuscitation during the next 28 days . The primary outcome measure was death from any cause during the 28-day period after r and omization . RESULTS Of the 6997 patients who underwent r and omization , 3497 were assigned to receive albumin and 3500 to receive saline ;  the two groups had similar baseline characteristics . There were 726 deaths in the albumin group , as compared with 729 deaths in the saline group ( relative risk of death , 0.99 ; 95 percent confidence interval , 0.91 to 1.09 ; P=0.87 ) . The proportion of patients with new single-organ and multiple-organ failure was similar in the two groups ( P=0.85 ) . There were no significant differences between the groups in the mean ( + /-SD ) numbers of days spent in the ICU ( 6.5+/-6.6 in the albumin group and 6.2+/-6.2 in the saline group , P=0.44 ) , days spent in the hospital ( 15.3+/-9.6 and 15.6+/-9.6 , respectively ; P=0.30 ) , days of mechanical ventilation ( 4.5+/-6.1 and 4.3+/-5.7 , respectively ; P=0.74 ) , or days of renal-replacement therapy ( 0.5+/-2.3 and 0.4+/-2.0 , respectively ; P=0.41 ) . CONCLUSIONS In patients in the ICU , use of either 4 percent albumin or normal saline for fluid resuscitation results in similar outcomes at 28 days BACKGROUND Baseline data collected on each patient at r and omisation in controlled clinical trials can be used to describe the population of patients , to assess comparability of treatment groups , to achieve balanced r and omisation , to adjust treatment comparisons for prognostic factors , and to undertake subgroup analyses . We assessed the extent and quality of such practice s in major clinical trial reports . METHODS A sample of 50 consecutive clinical -trial reports was obtained from four major medical journals during July to September , 1997 . We tabulated the detailed information on uses of baseline data by use of a st and ard form . FINDINGS Most trials presented baseline comparability in a table . These tables were often unduly large , and about half the trials inappropriately used significance tests for baseline comparison . Methods of r and omisation , including possible stratification , were often poorly described . There was little consistency over whether to use covariate adjustment and the criteria for selecting baseline factors for which to adjust were often unclear . Most trials emphasised the simple unadjusted results and covariate adjustment usually made negligible difference . Two-thirds of the reports presented subgroup findings , but mostly without appropriate statistical tests for interaction . Many reports put too much emphasis on subgroup analyses that commonly lacked statistical power . INTERPRETATION Clinical trials need a predefined statistical analysis plan for uses of baseline data , especially covariate-adjusted analyses and subgroup analyses . Investigators and journals need to adopt improved st and ards of statistical reporting , and exercise caution when drawing conclusions from subgroup findings Symptomatic severe malarial anaemia ( SMA ) has a high fatality rate of 30–40 % ; most deaths occur in children awaiting blood transfusion . Blood transfusion services in most of Africa are not capable of delivering adequate supplies of safe blood in a timely manner to critically ill children with SMA . Contrary to widely held belief , hypovolaemia , rather than heart failure , has emerged as a common complication in such children . We examined the safety of  pre‐transfusion management ( PTM )  by volume expansion , aim ed at stabilizing children and obviating the urgency for blood transfusion . Kenyan children with severe falciparum anaemia ( haemoglobin < 5 g/dl ) and respiratory distress were r and omly assigned to 20 ml/kg of 4·5 % albumin or 0·9 % saline or maintenance only ( control ) while awaiting blood transfusion . PTM was apparently safe since it did not lead to the development of pulmonary oedema or other adverse events . There was no significant difference in the primary outcome [ mean percentage reduction in base excess between admission and 8 h ( 95 % confidence interval ) ] between the control group 42 % ( 19–66 % ) albumin group 44 % ( 32–57 % ) and saline group 36 % ( 16–57 % ) ; adjusted analysis of variance F = 0·31 , P = 0·7 . However , the number of children requiring emergency interventions was significantly greater in the control group , four of 18 ( 22 % ) than the saline group 0 of 20 ( P = 0·03 ) . We have established the safety of this PTM in children with SMA whilst awaiting blood transfusion at a hospital with an adequate blood‐banking program . The impact on mortality should be assessed where blood transfusion services are unable to supply emergency transfusions BACKGROUND / AIMS Recent studies demonstrated that extravascular lung water ( EVLW ) is a reliable and independent marker for outcome . The primary therapeutically goal in critically ill patients is to resuscitate and retain adequate organ perfusion by fluid administration , where is necessary to achieve adequate intravascular filling , but avoid initiation of pulmonary edema . METHODOLOGY Patients with severe sepsis were r and omly allocated to a group treated with 20 % Albumin 100 ml every 12 hours ( ALB ; n = 30 ) or with 6 % hydroxyethylstarch 130/0 , 4 250 ml every 6 hours ( HES ; n = 26 ) . Both treatments were completed by crystalloids or norephinephrin as necessary . We analyzed amount of developed EVLW , and relation with mortality , PaO2/FiO2 and alveolo-arterial oxygen difference . RESULTS We observed significantly greater decrease of EVLW when compared with baseline during whole monitored period of 72 hours in ALB group in contrast to HES patients ( p < 0.05 ) . Despite no significant changes of EVLW in HES group , we noted improve of PaO2/FiO2 and AaDO2 in both groups . We did not observed significant difference in mortality . CONCLUSION The present study results show can summarize that albumin reduces in a higher amount and earlier the extravascular lung water than HES , but this reduction was not associated with improvement of oxygenation functions , which was better in HES group BACKGROUND Metabolic acidosis is the best predictor of death in children with severe falciparum malaria ; however , its treatment presents a therapeutic dilemma , because acidosis and hypovolemia may coexist with coma , which can be associated with elevated intracranial pressure . We postulated that volume resuscitation with albumin might correct acidosis and hypovolemia with a lower risk of precipitating cerebral edema than crystalloid . In an open-label , r and omized , controlled trial , we compared the safety of resuscitation with albumin to saline in Kenyan children with severe malaria . METHODS We r and omly assigned children with severe malaria and metabolic acidosis ( base deficit , > 8 mmol/L ) to receive fluid resuscitation with either 4.5 % albumin or normal saline . A control ( maintenance only ) group was only included for patients with a base deficit of < 15 mmol/L. The primary outcome measure was the percentage reduction in base deficit at 8 h. Secondary end points included death , the requirement for rescue therapies , and neurological sequelae in survivors . RESULTS Of 150 children recruited for the trial , 61 received saline , 56 received albumin , and 33 served as control subjects . There was no significant difference in the resolution of acidosis between the groups ; however , the mortality rate was significantly lower among patients who received albumin ( 3.6 % [ 2 of 56 patients ] ) than among those who received saline ( 18 % [ 11 of 61 ] ; relative risk , 5.5 ; 95 % confidence interval , 1.2 - 24.8 ; P=.013 ) . CONCLUSIONS In high-risk children with severe malaria and acidosis , fluid resuscitation with albumin may reduce mortality . Our study design did not enable us to determine whether saline administration is preferable to fluid restriction or whether saline administration is actually hazardous . Further studies are needed to confirm our findings before definitive treatment recommendations can be made Various vasoactive substances are involved in the regulation of the macro- and microcirculation . We have investigated if these regulators change during long-term volume therapy with human albumin ( HA ) or hydroxyethylstarch solution ( HES ) in trauma and sepsis patients . To maintain pulmonary capillary wedge pressure ( PCWP ) at 10 - 15 mm Hg , either 20 % HA ( HA-trauma , n = 14 ; HA-sepsis , n = 14 ) or 10 % low-molecular weight HES solution ( HES-trauma , n = 14 ; HES-sepsis , n = 14 ) were infused for 5 days , otherwise patient management did not differ between the two groups ( trauma/sepsis ) . Mean 
    Output:
    
In this meta- analysis , the use of albumin-containing solutions for the resuscitation of patients with sepsis was associated with lower mortality compared with other fluid resuscitation regimens .