The role of colloids in resuscitation

Abstract

Colloids have been used for many years in resuscitation yet few studies have thoroughly examined their usefulness. Colloids and a combination of crystalloids and colloids continue to be used without any real scientific basis. Scrutiny of review articles, experimental studies, and clinical investigations reveals conflicting and confusing data. There are too many variables to accurately interpret findings, cross species problems with animal studies, different fluids used making comparisons difficult if not impossible, and confounding variables that include: 1 Health status of the patients 2 Severity/type of injury 3 Complications (especially sepsis) 4 Varying grades of shock 5 Variable time scale of administration of fluids 6 Variable volumes administered 7 Differing methods of determining fluid volume depletion 8 Inconsistent monitoring 9 Differing endpoints 10 Different techniques to measure endpoints 11 Comparison of delayed treatment of traumatic shock with blood loss occurring during surgery of questionable validity. One of the areas that has been studied reasonably well is the allergic effects associated with colloid use and more recently the adverse effects associated with the use of dextrose solutions in patients with head injuries. The continued effort to develop satisfactory resuscitation solutions including the recent development of hypertonic saline solutions (usually in combination with a colloid) highlights the uncertainty that exists in relation to the true role of the colloid and crystalloid agents available. Recent studies question the use of fluids to resuscitate patients with penetrating torso injuries. The aim of this paper is to review what is known about the use of colloids and crystalloids in resuscitation and to recommend guidelines as to which fluid should be used in differing clinical situations.