[Colloids versus crystalloids in the treatment of hypovolemic or septic shock]

Abstract

The literature is reviewed with the aim of comparing the effect of resuscitation with colloid solutions with that of crystalloid solutions in the following patient categories: patients undergoing major elective abdominal surgery, patients in hypovolemic shock due to acute trauma and patients in septic shock. None of the clinical trials have documented that resuscitation with colloids is superior to that of crystalloids alone as regards mortality or frequency of complications. On the contrary, colloid resuscitation appears to be detrimental in patients with traumainduced hypovolemic shock with a higher incidence of pulmonary and cardiac complications as compared to resuscitation with crystalloids alone. This is contrary to what is expected from the Starling equation and the discrepancy between the theoretical and clinical findings is discussed. Furthermore, resuscitation with colloids is about 50 times more expensive than resuscitation with crystalloids. On the basis of the clinical data and the higher cost of colloids, the authors recommend cessation of the use of colloids in the abovementioned conditions.