In critically ill patients requiring fluid resuscitation, does albumin improve outcomes compared to normal saline? This landmark randomized controlled trial evaluated the safety and efficacy of albumin versus normal saline for fluid resuscitation in ICU patients. A total of 6997 patients from 16 ICUs in Australia and New Zealand were randomized to receive 4% albumin or normal saline for resuscitation. The study found no significant difference in 28-day mortality between the albumin and saline groups. Subgroup analyses showed no benefit of albumin in specific populations, including those with sepsis or trauma. Importantly, there was no significant difference in the incidence of new organ failure, length of ICU or hospital stay, or the need for renal replacement therapy between the groups. The findings demonstrated that albumin is as safe as saline for fluid resuscitation in critically ill patients but does not confer a survival advantage. This trial remains a cornerstone in guiding fluid therapy choices in the ICU.