Use of infusion solutions in critically ill: Literature review

Abstract

The treatment of critically ill patients relies upon a series of pathophysiological disorders arising in the present critical condition. Loss of circulatory volume is one in a series of disturbed mechanisms that require proper correction. Causes of circulatory volume loss, hemodynamic instability and inadequate tissue perfusion are different: in sepsis and burns due to the higher capillary permeability, in trauma because of massive bleeding, etc. Infusion solutions, crystalloids and colloids have their good and bad qualities, and therefore must be seen as agents with specific indications, contraindications and the recommended doses. Assessment of stage of the disease, the amount and type of solutions to be applied has an influence on the further course of the disease. After review of randomized studies and meta-analysis, comparing crystalloids and colloids, moderate difference in their efficacy but significant difference in their safety is observed. The high concentration of chloride ion in solutions is of great clinical importance. The possibility of iatrogenic renal failure, metabolic acidosis and coagulopathy requires caution when using synthetic colloids and isotonic saline solutions. Physiologically 'balanced' crystalloid solutions may be standard in the treatment of critically ill patients, while the role of colloids, especially Hydroxyethylstarch, is still unreliable.