[Role of albumin in pulmonary edema and septic shock, plasma volume expansion excluded].

Patients with septic shock deserve a global approach. Intravascular volume loading is part of the treatment. However several questions remain open: what are the respective contributions of volume expansion and vaso-active drugs in the restoration of blood pressure and increase of cardiac output, which volumes and type of solutions should be used, which pulmonary capillary wedge pressure should be targetted, and which evaluation criteria are the most appropriate? Few experimental and clinical studies provide evidence of a superiority of colloids over crystalloids, although none of them has documented a reduction of mortality, length of stay in ICU or duration of mechanical ventilation. There are no data support-ing a superiority of albumin over artificial colloids, which are also much cheaper. Moreover, hydroxyethylstarch could have promising properties in case of increased capillary permeability. In summary and in agreement with the North American consensus conference, albumin should not be recommended for the treatment of septic shock, whether associated with non cardiogenic pulmonary oedema or not.