The authors propose to investigate the ongoing controversy and debate surrounding the use of albumin in burns resuscitation; specifically they mention that the study is not investigating the use of albumin to correct hypoalbuminaemia. Mention is made of previously conducted meta-analysis that attempted to address the issue of mortality and albumin use in burns. The authors conduct a solid data search that identifies 164 studies, however only four of these studies were selected for evaluation. Detail is scant as to why so many trials were excluded, other than a mention that trials that involved patients with concurrent trauma or infection would not be included. More detail would have been appreciated on this matter, especially as other meta-analysis that the authors reference within the paper have analysed more than 40 randomised control trials (RCTs) and concurrent trauma is commonplace in major burns and as such the value of addressing the albumin question in such groups would seem reasonable. However, on the trials selected as suitable for study inclusion a good analysis is conducted given the small number of studies.
The authors demonstrate that their analysis reveals no significant benefit of albumin as a resuscitation fluid over non-albumin solutions on mortality in burns patients, however they also point out that the data suggests that a lower total volume of resuscitation fluid is required when utilising albumin. Unfortunately, as the authors recognise, due to the relatively low power of the study, firm recommendations relating to this contentious issue of albumin as a resuscitation product in burns remain unclear. However, this article represents a valuable contribution to the literature surrounding this difficult question and highlights very well the need for further work to delineate the matter.