This review article examines the role of albumin in critical illness, a condition where the distribution and metabolism of albumin are significantly altered. Albumin, the most abundant plasma protein, plays crucial roles in oncotic pressure, binding substances, metabolic function, acid-base balance, antioxidant function, maintaining microvascular integrity, and anticoagulant effects. In critical illness, albumin concentration decreases, leading to hypoalbuminemia, which is associated with poor outcomes. However, despite theoretical advantages, studies have shown that correcting hypoalbuminemia with human albumin solution does not improve outcomes in critically ill patients. The article discusses the structure and metabolism of albumin, its functions in health, and the implications of altered albumin dynamics in critical illness. It also reviews the use of exogenous albumin in managing critically ill patients, highlighting the lack of evidence supporting its benefits over other colloidal therapies. The article concludes by emphasizing the need for further research to identify specific patient groups who may benefit from albumin therapy.This review article examines the role of albumin in critical illness, a condition where the distribution and metabolism of albumin are significantly altered. Albumin, the most abundant plasma protein, plays crucial roles in oncotic pressure, binding substances, metabolic function, acid-base balance, antioxidant function, maintaining microvascular integrity, and anticoagulant effects. In critical illness, albumin concentration decreases, leading to hypoalbuminemia, which is associated with poor outcomes. However, despite theoretical advantages, studies have shown that correcting hypoalbuminemia with human albumin solution does not improve outcomes in critically ill patients. The article discusses the structure and metabolism of albumin, its functions in health, and the implications of altered albumin dynamics in critical illness. It also reviews the use of exogenous albumin in managing critically ill patients, highlighting the lack of evidence supporting its benefits over other colloidal therapies. The article concludes by emphasizing the need for further research to identify specific patient groups who may benefit from albumin therapy.