[Volume replacement in critically ill intensive-care patients. No classic review]

Effective fluid therapy is a mainstay of managing the critically ill. The ideal kind of volume replacement in this situation still remains a challenge. In spite of an immense number of contributions to this problem there is still no solution yet. This topic is often discussed emotionally rather than scientifically. The ideal solution should not only maintain gross hemodynamics, but organ perfusion and microcirculation should also be guaranteed or even improved. To treat hypovolemia, colloids are more often used in Germany than crystalloids. Particularly when long-term volume replacement is needed use of synthetic colloids is often restricted due to fear of negative side-effect on hemostasis, renal, liver, and immune function. Thus the use of the natural colloid human albumin is still preferred for volume therapy in this situation in several centers. However, there seems to be no convincing clinical advantage on patients' outcome for either solution. The lack of acceptance of synthetic colloids such as hydroxyethyl starch (HES) solution for volume replacement is most likely due to reports on abnormal coagulation function. This cannot be used as an argument when new modern HES preparations with low molecular weight (70,000 or 200,000 dalton) and low degree of substitution (0.5) are used.