Sepsis is a life-threatening organ dysfunction caused by a disordered response of the body to infection. 1 Septic shock is a phenomenon relating to sepsis and is a serious disorder involving both the circulatory system and cell metabolism. During septic shock, extremely low blood pressure is observed, and this requires use of a vasoactive drug after adequate volumetric resuscitation has been applied, in order to maintain average blood pressure ≥ 65 mmHg and lactate concentration ≥ 2 mmol/l. Septic shock is the most life-threatening subtype of sepsis, with a mortality rate of 20% to 45%. 2 Fluid resuscitation is a key component of treatments for sepsis and septic shock. Over the past 30 years, many randomized clinical trials (RCTs) and systematic reviews 3-8 that evaluated the therapeutic effects of various fluid resuscitation therapies on sepsis concluded that crystalloid and albumin were the most beneficial therapeutic agents, while use of artificial colloid was associated with a higher death rate and with adverse events. However, few RCTs and systematic reviews have compared the therapeutic effects of crystalloid and albumin regarding septic shock. 9-13 Moreover, the researchers involved in the studies available differed in their conclusions. 14-21 According to the findings from the Enhanced Recovery after Surgery (ERAS) study, 14 albumin does not reduce the mortality rate due to septic shock, whereas the findings from another large RCT called ALBIOS (NCT00707122) 15 concluded that fluid resuscitation using albumin could reduce the mortality rate from septic shock. In 2014, contrary results were reported in a meta-analysis by Patel et al., 16 which found that there was no difference between the effects from albumin and crystalloid treatment, while another meta-analysis by Xu et al. 17 reported that albumin treatment had positive results with regard to reducing the mortality rate among adult patients with septic shock. These studies have shown that it is not yet a foregone conclusion that albumin is superior to crystalloid for reducing the mortality rate in septic shock cases. In 2015, the Lactated Ringer Versus Albumin in Early Sepsis Therapy (RASP) RCT (NCT01337934) 18 specifically compared 4%

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