Cristalloids vs. colloids

I used to grow up with Macrodex and Promit on our ambulances. Then HAES came about and some albumin. In the first decade of this century, HAES fell into the abyss of the VISEP study, leaving gelatine for colloids. Now there is again evidence against that, so that we are left with albumin (some evidence for sepsis – see the SAFE study) and cristalloids and maybe some obscure stuff.

This course of modern volume therapy, in particular for sepsis, is beautifully illustrated by this ingeniously crafted study, which correlates acute kidney injury with the current volume replacement fluid of choice.

I am happy to say after at least 30 years of bitter debate that colloids have no place in volume replacement anymore, perhaps with the exception of Albumin and Macrodex (for which no proper data on harm exists). At least that is what the recent recommendations of ESCIM and Cochrane’s say (though with slightly more paragraphs). There might be some instances (cirrhosis, say) where albumin is particularly good, but that still has to be determined.

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