Crystalloid or colloid: does it matter?

Area of Science:

• Critical Care Medicine
• Anesthesiology
• Fluid Physiology

Background:

• The crystalloid-colloid debate regarding fluid resuscitation has persisted for over 25 years.
• Understanding fluid distribution, particularly in the interstitial space, is crucial for effective resuscitation after hemorrhage and hemorrhagic shock.

Purpose of the Study:

• To present a current appraisal of the crystalloid-colloid debate.
• To review the distribution of various crystalloids and colloids (albumin, polygeline, dextran 70, hydroxyethyl starch).
• To evaluate associated issues like edema, adverse reactions, and cost-effectiveness.

Main Methods:

• Literature review on fluid distribution and resuscitation strategies.
• Analysis of crystalloid and colloid properties and effects on fluid compartments.
• Review of adverse reactions, edema formation, and cost comparisons.
• Survey of attitudes in Australian anesthetic departments.

Main Results:

• The central issue in the debate is the effect on interstitial fluid volume.
• Crystalloids are indicated if interstitial fluid volume is reduced; colloids are more appropriate if it increases.
• The study reviews various colloids, their distribution, potential for edema, adverse effects, and cost.

Conclusions:

• The choice between crystalloids and colloids depends on their impact on interstitial fluid volume post-hemorrhage.
• Consideration of adverse reactions, edema, and cost is essential in fluid selection.
• A personal approach to fluid resuscitation is outlined based on these factors.