BMJ 1998;317:277 ( 25 July )

Letters

Fluid resuscitation with colloid or crystalloid solutions

    Comparing different studies is difficult
    Newer synthetic colloids should not be abandoned
    One conclusion could be that hypertonic saline is better than colloids in trauma
    Eight studies should have been excluded
    Use of dextran-70 for fluid resuscitation has been dying out
    Conditions and patient groups were too heterogeneous to allow meaningful comparisons
    Authors' reply
    Virtually identical article had appeared in Cochrane Library

Comparing different studies is difficult

Editorial by Offringa and Paper p 235

The first 150 words of the full text of this article appear below.

EDITORThe debate over giving crystalloids or colloids has been raging since the 19th century, when Cohnheim and Lichtheim found gastric mucosal oedema in patients who had been resuscitated with saline and Starling suggested that albumin could prevent oedema. ^{1 2} The meta-analysis by Schierhout and Roberts, which does not support the continued use of colloids for volume replacement in critically ill patients, makes a useful contribution to this debate but does not settle it.³

A recent review by Hankeln and Beez comes to the opposite conclusionthat colloids are more effective than crystalloids for optimising physiological variables related to flow in critically ill patients and maintaining the delivery of oxygen to the tissues²; they say that this is related to the persistence of colloids in the circulating plasma volume, as opposed to their distribution throughout the total body water.⁴ Although colloids are more expensive than crystalloids, their effect on . . . [Full text of this article]

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Rapid Responses:

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Mortality is the wrong end-point

A R Webb
bmj.com, 24 Jul 1998 [Full text]

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