***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The aim of this cross-over study was to investigate whether albumin infusion before furosemide administration could potentiate the diuretic action of furosemide .  Seven patients with nephrotic syndrome were given the following infusions in r and om order on two separate days : 1 ) a sham solution followed by 160 mg of furosemide , 2 ) 100 ml of 20 % human albumin followed by 160 mg of furosemide .  Urine and serum furosemide concentrations were measured by high-performance liquid chromatography . The increment of urine volume was greater in albumin preinfusion than in furosemide alone . However , the increments of sodium and chloride excretions between furosemide alone and albumin preinfusion were not different . No significant differences in the pharmacokinetic parameters between the two treatments were observed : area under the concentration-time curve ( AUC : 12.7+/-2.2 vs 15.1+/-4.4 g/ml hr ) , total plasma clearance ( 253+/-41 vs 256+/-54 ml/min ) , volume of distribution ( 341+/-34 vs 494+/-153 ml/kg ) , elimination half life ( 4.0+/-1.1 vs 4.6+/-0.8 hr ) , and urine furosemide excretion of the administered amount ( 16.5+/-7.3 vs 7.5+/-1.6 % ) . In conclusion , these data show that albumin preinfusion potentiated diuresis , but not natriuresis , of furosemide without any change in the pharmacokinetics of the agent in patients with nephrotic syndrome 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 To evaluate potential changes in the ratio of whole-body/large-vessel hematocrit ( f-cell ratio ) during isovolemic hemodilution and to compare the volume effects of 2 different plasma exchange solutions ( hydroxyethyl starch 200,000/0.62 6 % and human albumin 5 % ) . DESIGN Prospect i ve , r and omized , controlled trial . SETTING Operating theater in a university hospital . PATIENTS 24 gynecological patients scheduled for elective surgery . INTERVENTIONS Isovolemic hemodilution was performed using 2 different plasma exchange solutions .  Plasma volume was determined using dye dilution technique before and after hemodilution . The volume of withdrawn blood was measured from the change in weight of the blood bags taking into account the specific gravity of blood . RESULTS The volume of administered plasma exchange solutions exceeded the amount of withdrawn blood by 80 + /- 47 ml ( p < 0.001 ) . Plasma volume was 3,067 + /- 327 ml before and 3,517 + /- 458 ml after hemodilution . Using red cell volumes calculated from measured plasma volumes and peripheral hematocrit , a deficit of 249 + /- 133 ml ( p < 0.0001 ) in red cells after hemodilution appeared with the measured withdrawn red cell volumes taken into account . This finding can be explained by a change in the f-cell ratio during isovolemic hemodilution . The volume effect of the exchange solutions was 1.05 for hydroxyethyl starch and 0.95 for albumin . CONCLUSIONS The results demonstrate that a change in the f-cell ratio occurs during isovolemic hemodilution . The estimation of red cell volume or plasma volume changes by using either the hematocrit or plasma or red cell volume determinations together with the hematocrit may lead to erroneous results Background — Cognitive dysfunction is a common and disabling sequela of subarachnoid hemorrhage ( SAH ) . Although several clinical and radiographic findings have been implicated in the pathogenesis of cognitive dysfunction after SAH , few prospect i ve studies have comprehensively and simultaneously evaluated these risk factors . Methods — Between July 1996 and March 2000 , we prospect ively evaluated 113 of 248 consecutively admitted nontraumatic SAH patients alive at 3 months with a comprehensive neuropsychological evaluation .  Summary scores for 8 cognitive domains were calculated to express test performance relative to the entire study population . Clinical and radiographic variables associated with domain-specific cognitive dysfunction were identified with forward stepwise multiple regression , with control for the influence of demographic factors . Results — The study participants were younger ( P = 0.005 ) , less often white ( P = 0.006 ) , and had better 3-month modified Rankin scores ( P = 0.001 ) than those who did not undergo neuropsychological testing . The proportion of subjects who scored in the impaired range ( > 2 SD below the normative mean ) on each neuropsychological test ranged from 10 % to 50 % . Predictors of cognitive dysfunction in 2 or more domains in the multivariate analysis included global cerebral edema ( 4 domains ) , left-sided infa rct ion ( 3 domains ) , and lack of a posterior circulation aneurysm ( 2 domains ) . Other variables consistently associated with cognitive dysfunction in the univariate analysis included admission Hunt-Hess grade > 2 and thick SAH in the anterior interhemispheric and sylvian fissures . Conclusions — Global cerebral edema and left-sided infa rct ion are important risk factors for cognitive dysfunction after SAH . Treatment strategies aim ed at reducing neurological injury related to generalized brain swelling , infa rct ion , and clot-related hemotoxicity hold the best promise for improving cognitive outcomes after SAH 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 Intentional normovolemic hemodilution was chosen as the model to compare a 6 % low molecular weight hydroxyethyl starch ( LMW HES ) to 4 % albumin . The study ran over the plasma exchange period for 24 h. Nine patients , scheduled for abdominal aortic surgery , were included in each group . After basal measurements , blood was withdrawn and simultaneously replaced by either 4 % albumin ( Group 1 ) or 6 % LMW HES ( Group 2 ) to achieve a final hematocrit of approximately 30 % . Hemodynamic blood oxygen gas and hormonal plasma levels were determined before hemodilution then at 30 min , 1 , 2 , 3 , and 24 h after the end of hemodilution . Basal value for total blood volume was 4377±162 ml in group 1 and 4138±315 ml in group 2 . As in both groups the decrease in blood cell volume was exactly compensated by the increase in plasma volume , no significant change in total blood volume ( respectively 4432±159 and 4305±267 ml ) was observed . Throughout the study , in both groups , no significant change in mean arterial and right atrial pressures was observed . In group 2 ( LMW HES ) , a significant increase of pulmonary capillary wedge pressure was noted 120 min after hemodilution . After hemodilution , despite a significant decrease in arterial oxygen O2 content , systemic oxygen transport did not significantly vary until 24 h in relation to the increased cardiac index . An increase in O2 extraction was observed until the 24 h. No significant chagnes either in global O2 consumption or in lactate concentration were detected . Plasma renin activity fell in both groups while atrial natriuretic factor increased with a peak value at the 2 h. These data suggest that LMW HES as well as 4 % albumin was able to maintain at least normovolemia during a 24 h period after intentional hemodilution BACKGROUND The role of intensive insulin therapy in patients with severe sepsis is uncertain . Fluid resuscitation improves survival among patients with septic shock , but evidence is lacking to support the choice of either crystalloids or colloids . METHODS In a multicenter , two-by-two factorial trial , we r and omly assigned patients with severe sepsis to receive either intensive insulin therapy to maintain euglycemia or conventional insulin therapy and either 10 % pentastarch , a low-molecular-weight hydroxyethyl starch ( HES 200/0.5 ) , or modified Ringer 's lactate for fluid resuscitation . The rate of death at 28 days and the mean score for organ failure were co primary end points . RESULTS The trial was stopped early for safety reasons . Among 537 patients who could be evaluated , the mean morning blood glucose level was lower in the intensive-therapy group ( 112 mg per deciliter [ 6.2 mmol per liter ] ) than in the conventional-therapy group ( 151 mg per deciliter [ 8.4 mmol per liter ] , P<0.001 ) . However , at 28 days , there was no significant difference between the two groups in the rate of death or the mean score for organ failure . The rate of severe hypoglycemia ( glucose level , < or = 40 mg per deciliter [ 2.2 mmol per liter ] ) was higher in the intensive-therapy group than in the conventional-therapy group ( 17.0 % vs. 4.1 % , P<0.001 ) , as was the rate of serious adverse events ( 10.9 % vs. 5.2 % , P=0. 
    Output:
    
In surgery , hyperoncotic albumin preserved renal function and reduced intestinal edema compared with control fluids .
In trauma and sepsis , cardiac index and oxygenation were higher after administration of hydroxyethyl starch than hyperoncotic albumin .
Improved treatment response and renal function , shorter hospital stay and lower costs of care were reported in patients with liver disease receiving hyperoncotic albumin .
Edema and morbidity were decreased in high-risk neonates after hyperoncotic albumin administration .
Disability was reduced by therapy with hyperoncotic albumin in brain injury .
There was no evidence of deleterious effects attributable to hyperoncotic albumin .
Conclusion In some clinical indications , r and omized trial evidence has suggested certain benefits of hyperoncotic albumin such as reductions in morbidity , renal impairment and edema .