Comparative Evaluation of Albumin and Starch Effects in Acute Lung Injury (ALI)

Inclusion Criteria: * Consensus clinical definition of ALI or ARDS: * Partial pressure of oxygen in arterial blood to the fraction of inspired oxygen (PaO2 / FiO2) ratio ≤ 200 (ARDS) or ≤ 300 (ALI), and; * Bilateral infiltrates on chest x-ray, and; * No clinical evidence of congestive heart failure, and; * Pulmonary artery occlusion pressure (PAOP) ≤ 18 mm Hg, if a pulmonary arterial catheter is present * Serum total protein concentration \< 6.0 g/dL. * Endotracheal intubation and mechanical ventilation ≥ 24 hours. Exclusion Criteria: * Hemodynamic instability within the prior 24 hours: (either of the following) * Ongoing fluid resuscitation defined as \> 2 liters of crystalloid boluses or \> 4 units of blood products transfused in the prior 24-hour period. * Vasopressor support exceeding any of the following: * Dopamine or dobutamine \> 5 mcg/kg/min, or in combination at any dose; or * Any other vasoactive agent (i.e. epinephrine, norepinephrine, phenylephrine) * Significant renal disease (either of the following at the time of screening): * End-stage renal disease, or * Renal insufficiency with serum creatinine ≥ 3.0 mg/dL or urine output \< 500cc/24 hrs * Allergy to albumin, hetastarch or furosemide. * Increased risk for bleeding: * Within 72 hours of any surgical procedure requiring use of the operating room, or * Any current or previously diagnosed bleeding disorder, or * History of any intracranial abnormality (including, but not limited to, intracranial arteriovenous malformations, subdural/subarachnoid/intracerebral hemorrhage, intracranial mass lesions) or traumatic brain injury with Glasgow Coma Scal (GCS) \< 9 in the prior 14 days, or * Prothrombin time international normalized ratio (INR) \> 2.0, partial thromboplastin time (PTT) \> 1.5 times control, platelet count \< 50,000/cc3 * Risk for worsening pulmonary edema due to systolic heart failure. * Technical pulse contour analysis limitations: * Absence of central venous catheter, clinical arterial vascular disease, severe hypothermia (core temperature \< 94°F), weight \< 40 kg or \> 250 kg, clinically significant bleeding diathesis. * Failure of the patient or nearest relative to provide informed consent. * Refusal of the patient's attending physician to provide consent to participate. * Age \< 18 years. * Pregnancy. * Inability to quantify urine output (e.g. absence of bladder or bladder catheter). * Significant hypokalemia (K+ \< 3.5 meq/L), hypernatremia (Na+ \> 155 meq/L) or hypomagnesemia (Mg \< 1.0 meq/L) * Patient meets criteria for weaning mechanical ventilation: * Required FiO2 ≤ 0.40 and positive end-expiratory pressure (PEEP) ≤ 5, and; * Spontaneous tidal volumes \> 5 ml / kg, and; * Spontaneous respiratory rate \< 20 / minute, and; * Capable of spontaneous ventilation on continuous positive airway pressure (CPAP)=5, pressure support (PS)=5. * Expected survival ≤ 120 hours.