***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND AND PURPOSE Cerebral blood flow ( CBF ) is reduced after subarachnoid hemorrhage ( SAH ) , and symptomatic vasospasm is a major cause of morbidity and mortality . Volume expansion has been reported to increase CBF after SAH , but CBF values in hypervolemic ( HV ) and normovolemic ( NV ) subjects have never been directly compared . METHODS On the day after aneurysm clipping , we r and omly assigned 82 patients to receive HV or NV fluid management until SAH day 14 . In addition to 80 mL/h of isotonic crystalloid , 250 mL of 5 % albumin solution was given every 2 hours to maintain normal ( NV group , n=41 ) or elevated ( HV group , n=41 ) cardiac filling pressures . CBF ( (133)xenon clearance ) was measured before r and omization and approximately every 3 days thereafter ( mean , 4.5 studies per patient ) . RESULTS HV patients received significantly more fluid and had higher pulmonary artery diastolic and central venous pressures than NV patients , but there was no effect on net fluid balance or on blood volume measured on the third postoperative day . There was no difference in mean global CBF during the treatment period between HV and NV patients ( P=0.55 , r and om-effects model ) . Symptomatic vasospasm occurred in 20 % of patients in each group and was associated with reduced minimum regional CBF values ( P=0.04 ) . However , there was also no difference in minimum regional CBF between the 2 treatment groups . CONCLUSIONS HV therapy result ed in increased cardiac filling pressures and fluid intake but did not increase CBF or blood volume compared with NV therapy . Although careful fluid management to avoid hypovolemia may reduce the risk of delayed cerebral ischemia after SAH , prophylactic HV therapy is unlikely to confer an additional benefit To assess the effects of crystalloid and colloid resuscitation on hemodynamic response and on lung water  following thermal injury , 79 patients were assigned r and omly to receive lactated Ringer 's solution or 2.5 % albumin-lactated Ringer 's solution . Crystalloid-treated patients required more fluid for successful resuscitation than did those receiving colloid solutions ( 3.81 vs. 2.98 ml/kg body weight/% body surface burn , p < 0.01 ) . In study phase 1 ( 29 patients ) , cardiac index and myocardial contractility ( ejection fraction ' and mean rate of internal fiber shortening , Vcf ) were determined by echocardiography during the first 48 hours postburn . Cardiac index was lower in the 12-to 24-hour postburn interval in the crystalloid group , but this difference between treatment groups had disappeared by 48 hours postburn . Ejection fractions were normal throughout the entire study , while Vcf was supranormal ( p < 0.01 vs. normals ) and equal in the two resuscitation groups . In study phase 2 ( SO patients ) , extravascular lung water and cardiac index were measured by a st and ard rebreathing technique at least daily for the first postburn week . Lung water remained unchanged in the crystalloid-treated patients ( p > 0.10 ) , but progressively increased in the colloid-treated patients over the seven day study ( p < 0.0001 ) . The measured lung water in each treatment group was significantly different from one another ( p < 0.001 ) . Cardiac index increased progressively and identically in both treatment groups over the study period ( p < 0.01 ) . These data refute the existence of myocardial depression during postburn resuscitation and document hypercontractile left ventricular performance . The addition of colloid to crystalloid resuscitation fluids produces no long lasting benefit on total body blood flow , and promotes accumulation of lung water when edema fluid is being reabsorbed from the burn wound In a prospect i ve r and omized trial of 16 patients undergoing abdominal vascular reconstructive procedures  , changes in plasma volume , serum oncotic pressure ( pis ) , serum albumin and total protein concentration , alveolar to arterial oxygen tension differences ( AaDO2 , FIO2 = 1.0 ) , creatinine clearance , body weight , and fluid and sodium intake were examined . By r and om assignment patients received either an albumin- or a sodium-rich intraoperative fluid regimen .  Pulmonary arteriovenous admixture was significantly less in the albumin group ( n = 7 ) than in the electrolyte group ( n = 9 ) on the first postoperative day . The change in AaDO2 correlated positively with the total sodium intake in the electrolyte group . Despite the larger fluid load and significantly greater gain of body weight , patients in the electrolyte group had a postoperative plasma volume significantly lower than the preoperative value . Postoperative values of albumin concentration , circulating albumin mass and pis were significantly greater in the albumin group in comparison to the electrolyte group . Creatinine clearance values were not different between the two groups . The change in pis correlated significantly with sodium intake and circulating albumin mass . Pulmonary shunting and expansion of the extracellular fluid volume may be minimized without adverse effects on renal function by administration of fluids rich in albumin in preference to sodium OBJECTIVE To determine the effect of normovolaemic haemodilution in patients after a cerebrovascular accident . DESIGN Prospect i ve , r and omized clinical trial . SETTING St Lucas Hospital , Amsterdam . METHOD Normovolaemic haemodilution was achieved by means of bloodletting and administration of a 20 % solution of albumin plus crystalline infusion fluids under haemodynamic and rheological monitoring during the acute phase of the cerebral infa rct ion . All patients were subjected to general intensive care and monitoring with a pulmonary artery catheter . This custom-tailored fluid therapy was guided by a pulmonary wedge pressure of 12 mm Hg ( SD 3 ) and a haematocrit ( Ht ) of 0.32 l/l ( SD 0.02 ) . The control group only received individually dosed rehydration with crystalline infusion fluids . Endpoints of the study after 3 months were mortality and dependence/independence concerning everyday functioning . RESULTS The results in the total haemodilution group and the control group did not differ significantly . However , in the subgroup with normal Ht ( < 0.45 l/l ; n = 201 ) there was a significant reduction ( p < 0.05 ) of the mortality after 3 months ( 27 % and 16 % , respectively ) and an increase of independence at home ( 35 % and 48 % , respectively ) due to a reduction of the viscosity by means of haemodilution with albumin ( a specific viscosity effect in the normovolaemic group ) . In the control group with raised Ht ( dehydration ; Ht > or = 0.45 l/l ; n = 50 ) there was a significant decrease ( p < 0.005 ) of the mortality after 3 months ( 27 % and 8 % , respectively ) and an increase of independence at home ( 35 % and 59 % , respectively ) compared with the control group with normal Ht without signs of dehydration ( Ht < 0.045 l/l ; n = 102 ) , due to rehydration exclusively with crystalline infusion fluids ( a specific rehydration effect in the dehydrated group ) . CONCLUSION In cerebrovascular accident patients haemodilution should be adjusted individually ; in normovolaemic patients haemodilution should be carried out with an albumin solution ; the higher the Ht , the more rehydration with crystalline infusion fluids is to be carried out 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 OBJECTIVE To determine whether replacement of human albumin will improve a patient 's prognosis . DESIGN A r and omized , double-blind , controlled study in which 25 g of human albumin vs. placebo was administered intravenously daily . SETTING A university-affiliated hospital . PATIENTS Thirty-six patients with hypoalbuminemia ( serum albumin of < 2.5 g/dL ) , receiving total parenteral nutrition . None of the patients had known cancer , cirrhosis , or nephrotic syndrome . INTERVENTIONS Each patient received at least 6 days of therapy ( 6 to 24 days of albumin ; 7 to 32 days of placebo ) . Four subjects were excluded from the study since they received therapy for < 6 days . One patient was excluded from the study after nephrotic syndrome was identified . Albumin metabolic rates for those patients receiving albumin were estimated using the formula : Metabolism of albumin = 25 g/day + ( albumin 1 - albumin 2)(Vd)/days , where albumin 1 and 2 are the serum albumin concentrations ( g/L ) at the beginning and end of the serum sampling intervals , respectively ; Vd is the volume of distribution ( L ) ; and days relates to the number of days of the sampling interval . MEASUREMENTS AND MAIN RESULTS Sixteen patients received albumin ; 15 patients received placebo . One patient receiving placebo and two patients receiving albumin  died within 30 days . One patient who received placebo and three patients who received albumin developed sepsis or bacteremia ; four patients who received placebo and seven patients who received albumin developed pneumonia during the study ( NS ) . The serum albumin increased in all patients receiving intravenous albumin , but one patient received intravenous albumin for only 6 days . The mean serum albumin concentration increased by 1.42 g/dL in the albumin patients , and increased by 0.29 in the placebo patients ( p < .0001 by unpaired t-test ) . Mean initial albumin metabolism was 17.4 g/day ( 0.3 g/kg/day ) . At the end of therapy , albumin metabolism was 20.5 g/day ( 0.36 g/kg/day ) ( paired t-test , p = .4 , NS ) . CONCLUSIONS a ) The administration of intravenous albumin to hypoalbuminemic patients receiving total parenteral nutrition does not improve morbidity or mortality . b ) Albumin metabolic rates , initially related to the catabolic state , are high ; later , these rates are high related to filling of the albumin space and gluconeogenesis . c ) On the basis of the high albumin catabolic rates at the end of the infusion , doses of albumin of < 25 g/day might be sufficient to replace albumin stores The effects of concurrent administration of albumin with total parenteral nutrition were studied in 12 premature newborns ( birth weight 1.26 + /- 0.1 kg [ mean + /- SEM ] and gestational age 30 + /- 0.8 weeks [ mean + /- SEM ] ) compared with a control group of 12 premature newborns ( birth weight 1.17 + /- 0.2 kg and gestational age 29 + /- 0.1 weeks ) who received total parenteral nutrition . All newborns had a plasma albumin level below 3 g/dL and were in cardiorespiratory distress requiring assisted ventilation .  Albumin supplementation of total parenteral nutrition result ed in a sustained increase in serum albumin concentration as well as increased mean arterial blood pressures in the study group . Slow albumin infusion had no observed effect on the severity of respiratory distress . Study group infants regained birth weight earlier than control group infants . These data suggest that the concurrent administration of albumin may be clinical ly beneficial in critically ill newborn infants Patients with colorectal cancer undergoing elective surgery with resection of the tumour and primary anastomosis were r and omly allocated into two groups . 29 patients received a total of 60 - 75 g of 
    Output:
    
For patients with hypovolaemia , there is no evidence that albumin reduces mortality when compared with cheaper alternatives such as saline .
There is no evidence that albumin reduces mortality in critically ill patients with burns and hypoalbuminaemia .