Letter

Fluid resuscitation with colloid or crystalloid solutions

BMJ 1998; 317 doi: 10.1136/bmj.317.7153.277 (Published 25 July 1998)
Cite this as: BMJ 1998;317:277

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Comparing different studies is difficult

  1. J Watts, Consultant anaesthetist
  1. Burnley General Hospital, Burnley BB10 2PQ
  2. Department of Clinical Biochemistry, University Hospital Birmingham NHS Trust, Birmingham B29 6JD
  3. Western Infirmary, Glasgow G11 6NT
  4. Department of Anaesthesia, St George's Hospital, London SW17 0QT
  5. Department of Anaesthesia and Intensive Care, West Middlesex University Hospital, Isleworth, Middlesex TW7 6AF
  6. Royal Brompton Hospital, London SW3 6NP
  7. Guy's Hospital, London SE1 9RT
  8. Department of Epidemiology and Public Health, Institute of Child Health, University College London Medical School, London WC1N 1EH
  9. Hereford Hospitals NHS Trust, County Hospital, Hereford HR1 2ER

    Editorial by Offringa and Paper p 235

    EDITOR—The 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. 12The 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 conclusion—that 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.4Although colloids are more expensive than crystalloids, their effect on the circulating volume lasts much longer. The real problem is the difficulty in comparing different studies, because of differences in case mix, resuscitation protocols, and volumes and types of fluids used and, therefore, in making firm conclusions about patient outcome.

    In all cases of hypovolaemia the main priority is to restore the circulatory volume as quickly and efficiently as possible to prevent impairment of organs due to ischaemia and hypoxaemia.5 Maybe we will never have a definitive answer to this question, in which case many practitioners will continue to administer a judicious mix of both types of fluid according to their own experience.

    References

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      1. Watts JC,
      2. McConachie IM
      .A history of the use of steroids in septic shock. A time for re-appraisal.Int J Intensive Care1995; 2:22–26.
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    2. ↵
      1. Hankeln KB,
      2. Beez M
      .Haemodynamic and oxygen transport correlates of various volume substitutes in critically ill in-patients with various aetiologies of haemo-dynamic instability.Int J Intensive Care1998; 5:8–14.
    3. ↵
      1. Schierhout G,
      2. Roberts I
      .Fluid resuscitation with colloid or crystalloid solutions in critically ill patients: a systematic review of randomised trials.BMJ1998; 316:961–964(28 March.)
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      1. Astiz ME,
      2. Galera-Santiago A,
      3. Racrow E
      .Intravascular volume and fluid therapy for severe sepsis.New Horizons1993; 1:127–135
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      1. Hillman K,
      2. Bishop G,
      3. Bristow P
      .Fluid resuscitation.Curr Anaes Crit Care1996; 7:187–191.

    Newer synthetic colloids should not be abandoned

    1. Peter Gosling, Consultant clinical biochemist.
    1. Burnley General Hospital, Burnley BB10 2PQ
    2. Department of Clinical Biochemistry, University Hospital Birmingham NHS Trust, Birmingham B29 6JD
    3. Western Infirmary, Glasgow G11 6NT
    4. Department of Anaesthesia, St George's Hospital, London SW17 0QT
    5. Department of Anaesthesia and Intensive Care, West Middlesex University Hospital, Isleworth, Middlesex TW7 6AF
    6. Royal Brompton Hospital, London SW3 6NP
    7. Guy's Hospital, London SE1 9RT
    8. Department of Epidemiology and Public Health, Institute of Child Health, University College London Medical School, London WC1N 1EH
    9. Hereford Hospitals NHS Trust, County Hospital, Hereford HR1 2ER

      EDITOR—In their meta-analysis of trials that compared colloids with crystalloids in critically ill patients Schierhout and Roberts found increased mortality in patients treated with colloids and concluded: “this systematic review does not support the continued use of …

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