Crystalloids versus colloids: the end of an old debate?

Abstract

SUMMARY The ‘ideal’ plasma substitute for volume replacement remains a matter of dispute. Merits and demerits of colloids versus crystalloids for volume replacement have been discussed very emotionally. Are we any wiser concerning the crystalloid/colloid problem? Recently published meta‐analyses or evidence‐based medicine analyses appear to be less helpful to solve this problem. Conflicting results from different studies are most likely as a result of variations in clinical protocols, selection of patients, criteria for blood or volume administration. With their conflicting results more questions arise than answers are given.

Meta-Analysis of Fluids and Electrolytes Balance in Postoperative Patients

“…While a majority of previous studies done cited colloids and crystalloids as the primary components of replacement fluids used on postoperative patients, there seemed to be a significant agreement on the discussions done by different scholars, on the type of replacement fluid that is beneficial than the other. However, from a broader perspective, fluid replacement and fluid resuscitation in postoperative patients are directly related to the replacement of the standard blood volume with intravenous (IV) fluids which are intended to maintain the patient's adequate organ perfusion that also ensures healthy body metabolic processes (18) . Usually, the types of intravenous fluids that are primarily used in postoperative fluid replacement are those fluids that are within the group of volume expanders.…”

Traumatic coagulopathy‐Part 2: Resuscitative strategies

“…The topic relating to the optimal resuscitative fluid type (ie, crystalloid versus colloid) also remains controversial. Interestingly though, to date, there is no absolute evidence from randomized clinical trials in human or veterinary medicine showing that one fluid type is superior to another for improving overall survival . In fact, there is also no clinical trial demonstrating that one isotonic crystalloid is superior to another; although, lactated Ringer's solution composed of the l ‐lactate isomer only has been shown to exert less adverse immunoinflammatory effects as compared to the racemic ( d ‐ and l ‐isomer) lactated Ringer's solution and normal physiological saline…”

“…Controversy and confounding evidence also still surrounds the “crystalloid versus colloid” debate . As compared to isotonic crystalloids, nonprotein colloids (ie, hydroxyethyl starches, dextrans, gelatins) can increase and sustain vascular volume with significantly smaller volumes of infusion.…”

Editorial: recent advances in perioperative volume replacement therapy through a more physiological approach of the high-risk surgical patient

“…The concept that the type of solution to be used will depend on the physiological space that needs to be restored. Both crystalloids and colloids should be part of the armamentarium to treat hypovolemia in our patients 10 …”

“…Both crystalloids and colloids should be part of the armamentarium to treat hypovolemia in our patients. 10 The present special issue of Transfusion Alternatives in Transfusion Medicine aims at reviewing all these important advances. Recognized experts who have personally contributed to these advances have kindly accepted to participate in this issue.…”