The fluid of choice for resuscitation of severe shock

The choice of fluid for resuscitation in severe shock remains controversial. The various solutions commercially available have been compared in a standardized canine refractory shock model. The use of colloidal solutions proved preferable to the use of crystalloid solutions alone, as judged by oxygen debt, the volume required and the evidence of pulmonary overload. The three colloidal solutions studied, namely dextran 70, hydroxyethyl starch and Haemaccel (polygeline), produced very similar results. The clinical absence of reported serious side effects would suggest that Haemaccel is likely to be the colloidal fluid of choice. However, in the model studied, the use of a mixture of crystalloid and colloid produced results that were significantly better than either crystalloid or colloid alone. It is concluded that much of the controversy between crystalloid and colloid is artificial and that a mixture of these substances will be required in the resuscitation of the severely shocked patient.