Crystalloid or colloid: does it matter?

The modern version of the crystalloid-colloid debate has continued for more than 25 years, and a current appraisal of the debate is presented here. Although the effect of crystalloids and colloids on intravascular volume is important, their effect on interstitial fluid volume after hemorrhage and hemorrhagic shock is central to the debate. If reduced, crystalloids are appropriate as part of the resuscitation regime; if increased, colloid therapy is more logical. A brief review of the distribution of crystalloids and currently used colloids (albumin, polygeline, dextran 70, and hydroxyethyl starch) is presented. The problems of pulmonary and peripheral edema also are presented, as is an appraisal of adverse reactions to colloids together with a cost comparison of crystalloids and colloids. The results of a survey of attitudes at the major Australian anesthetic departments are given, and a personal approach to fluids in resuscitation is outlined.