[Crystalloids and colloids: fluid homeostasis and toxicity]

Area of Science:

• Critical Care Medicine
• Nephrology
• Intensive Care Unit (ICU) Management

Background:

• Fluid balance is vital in critically ill patients due to impaired compensatory mechanisms.
• Fluid overload poses significant risks, necessitating careful fluid status assessment and maintenance by ICU staff.
• Infusion fluids are categorized into colloids and crystalloids, each with distinct clinical implications.

Purpose of the Study:

• To compare the efficacy and safety of balanced crystalloid solutions versus 0.9% saline.
• To evaluate the benefits and risks associated with hydroxyethyl starch (HES) in critically ill patients.
• To emphasize the importance of judicious fluid management in the ICU setting.

Main Methods:

• Comparative analysis of fluid administration strategies.
• Review of clinical outcomes including acidosis, acute kidney injury, and mortality.
• Assessment of adverse events associated with different fluid types, particularly HES.

Main Results:

• Balanced crystalloid solutions demonstrate superiority over 0.9% saline regarding acidosis, acute kidney injury, and mortality.
• Hydroxyethyl starch (HES) offers a greater volume effect compared to crystalloids but carries risks.
• Adverse effects of HES include anaphylactic reactions and acute kidney injury, necessitating caution.

Conclusions:

• Balanced crystalloid solutions are recommended over 0.9% saline for fluid resuscitation in critically ill patients.
• The use of hydroxyethyl starch (HES) in critically ill patients, especially those with or at risk of kidney dysfunction, requires careful consideration due to potential adverse effects.
• Judicious fluid management and selection of appropriate infusates are paramount for optimizing outcomes in critical care settings.