Crystalloids or colloids for fluid resuscitation – is that the question?

Abstract

Fluid resuscitation is the most commonly applied treatment to critically ill patients and both crystalloids and colloids have saved thousands of lives. The debate of all crystalloids versus all colloids is increasingly irrelevant and misguided. Colloids are enormously variable and meta-analyses putting all colloids together into one group versus crystalloids are misleading. Critically ill patients form a very heterogeneous group and evidence is mounting which supports early subdivision into clinical entities and a more individualized treatment approach. All patients with hypovolaemia need water and salt, but when, how much and in what concentration? We should match the fluids used to the patient's condition. In patients with evidence of systemic capillary leak syndrome, modern medium molecular weight hydroxyethyl starches have shown definite advantages over albumin and low-molecular-weight gelatines.