In this randomized trial, we found that the use of 4 percent albumin or normal saline for intravascular volume resuscitation in a heterogeneous population of patients in the ICU resulted in equivalent rates of death from any cause during the 28-day study period.

Requirements for mechanical ventilation and renal-replacement therapy, time spent in the ICU and in the hospital during the 28-day study period, and the time until death (among the patients who died) were also equivalent.

The proportion of patients in the two groups in whom new single-organ or multiple-organ failure developed were similar.

Our findings do not support the results of the Cochrane Injuries Group Albumin Reviewers’ meta-analysis, which suggested that the use of albumin was associated with an increased mortality rate among critically ill patients.

Our study was conducted as a double-blind, randomized trial.

Albumin and saline are not considered equipotent intravascular volume expanders, but their relative potencies have not previously been examined in an adequately powered, blinded trial.

In our study, patients who were resuscitated with albumin received less fluid than those who were resuscitated with saline.

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