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Colloids vs. crystalloids--a continuing controversy.

A D Ross, D M Angaran

    Drug Intelligence & Clinical Pharmacy
    |March 1, 1984
    PubMed
    Summary
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    The crystalloid versus colloid debate centers on optimal fluid resuscitation for shock patients. This review examines Starling's law, edema types, and key studies to clarify fluid replacement strategies.

    Area of Science:

    • Critical Care Medicine
    • Physiology
    • Pharmacology

    Background:

    • The crystalloid vs. colloid debate questions the best method for maintaining plasma volume in shock.
    • Understanding fluid movement via Starling's law is crucial for evaluating resuscitation strategies.

    Purpose of the Study:

    • To review the crystalloid-colloid controversy in fluid resuscitation.
    • To analyze Starling's law in cardiogenic and noncardiogenic pulmonary edema.
    • To compare the efficacy, safety, and economics of crystalloids and colloids.

    Main Methods:

    • Review of colloid-crystalloid literature and major supporting studies.
    • Analysis of Starling's law components in different edema types.
    • Detailed discussion of major colloids (albumin, dextran, hetastarch) and a crystalloid (lactated Ringer's).

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    Main Results:

    • Differences in Starling's law components are highlighted for cardiogenic and noncardiogenic pulmonary edema.
    • Key studies supporting both crystalloid and colloid use are examined, along with their limitations.
    • A comparative table summarizes product data including composition, volume expansion, and adverse effects.

    Conclusions:

    • Areas of agreement between crystalloid and colloid proponents in fluid resuscitation are identified.
    • Comprehensive data on specific colloids and a representative crystalloid are provided for informed clinical decisions.
    • The review aims to clarify the ongoing debate on optimal fluid therapy in shock management.