***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: 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 Objective Crystalloids , artificial and natural colloids have been opposed as representing different strategies for shock resuscitation , but it may be relevant to distinguish fluids based on their oncotic characteristics . This study assessed the risk of renal adverse events in patients with shock resuscitated using hypooncotic colloids , artificial hyperoncotic colloids , hyperoncotic albumin or crystalloids  , according to physician ’s choice . Participants and setting International prospect i ve cohort study including 1,013 ICU patients needing fluid resuscitation for shock . Patients suffering from cirrhosis or receiving plasma were excluded . Measurements and results Influence of different types of colloids and crystalloids on the occurrence of renal events ( twofold increase in creatinine or need for dialysis ) and mortality was assessed using multivariate analyses and propensity score . Statistical adjustment was based on severity at the time of resuscitation , risks factor for renal failure , and on variables influencing physicians ’ preferences regarding fluids . A renal event occurred in 17 % of patients . After adjustment on potential confounding factors and on propensity score for the use of hyperoncotic colloids , the use of artificial hyperoncotic colloids [ OR : 2.48 ( 1.24–4.97 ) ] and hyperoncotic albumin [ OR : 5.99 ( 2.75–13.08 ) ] was significantly associated with occurrence of renal event . Overall ICU mortality was 27.1 % . The use of hyperoncotic albumin was associated with an increased risk of ICU death [ OR : 2.79 ( 1.42–5.47 ) ] . Conclusions This study suggests that harmful effects on renal function and outcome of hyperoncotic colloids may exist . Although an improper usage of these compounds and confounding factors can not be ruled out , their use should be regarded with caution , especially because suitable alternatives exist BACKGROUND Hydroxyethyl starch ( HES ) [ corrected ] is widely used for fluid resuscitation in intensive care units ( ICUs ) , but its safety and efficacy have not been established in patients with severe sepsis . METHODS In this multicenter , parallel-group , blinded trial , we r and omly assigned patients with severe sepsis to fluid resuscitation in the ICU with either 6 % HES 130/0.42 ( Tetraspan ) or Ringer 's acetate at a dose of up to 33 ml per kilogram of ideal body weight per day . The primary outcome measure was either death or end-stage kidney failure ( dependence on dialysis ) at 90 days after r and omization . RESULTS Of the 804 patients who underwent r and omization , 798 were included in the modified intention-to-treat population . The two intervention groups had similar baseline characteristics . At 90 days after r and omization , 201 of 398 patients ( 51 % ) assigned to HES 130/0.42 had died , as compared with 172 of 400 patients ( 43 % ) assigned to Ringer 's acetate ( relative risk , 1.17 ; 95 % confidence interval [ CI ] , 1.01 to 1.36 ; P=0.03 ) ; 1 patient in each group had end-stage kidney failure . In the 90-day period , 87 patients ( 22 % ) assigned to HES 130/0.42 were treated with renal-replacement therapy versus 65 patients ( 16 % ) assigned to Ringer 's acetate ( relative risk , 1.35 ; 95 % CI , 1.01 to 1.80 ; P=0.04 ) , and 38 patients ( 10 % ) and 25 patients ( 6 % ) , respectively , had severe bleeding ( relative risk , 1.52 ; 95 % CI , 0.94 to 2.48 ; P=0.09 ) . The results were supported by multivariate analyses , with adjustment for known risk factors for death or acute kidney injury at baseline . CONCLUSIONS Patients with severe sepsis assigned to fluid resuscitation with HES 130/0.42 had an increased risk of death at day 90 and were more likely to require renal-replacement therapy , as compared with those receiving Ringer 's acetate . ( Funded by the Danish Research Council and others ; 6S Clinical Trials.gov number , NCT00962156 . ) 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 Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background and objective To examine the kinetics of volume loading with crystalloid and colloid infusions in critically ill patients after major surgery , using the pulse contour cardiac 
    Output:
    
In this analysis , human albumin solutions as part of fluid volume expansion and resuscitation for critically unwell adults with sepsis of any severity ( with or without baseline hypoalbuminaemia ) were not robustly effective at reducing all-cause mortality .