Saturday, November 01, 2014

What's the ideal IV fluid?

Here's a review from Current Opinion in Critical Care Medicine.

Take home messages:

The colloid versus crystalloid debate remains unsettled.

Starch preparations are to be discouraged.

Among crystalloid solutions an emerging literature favors balanced solutions over saline. This however needs to be confirmed in higher level studies.

From the review:

Intravenous fluids, historically described as crystalloids or colloids, are administered with the aim of maintaining acceptable cardiac output and preserving the microcirculation. Achieving the aim of fluid administration is impacted by alterations in vascular permeability in critically ill patients. There is a strong body of evidence demonstrating the harmful effects of HES preparations, specifically regarding tissue storage with associated adverse renal, hepatic, cutaneous and haematological outcomes. The use of human colloids is limited by resource constraints, infectious and noninfectious risks. Hyperchloraemia, a well documented undesirable effect from administration of 0.9% saline, currently the most commonly prescribed crystalloid, is proinflammatory and is associated with increased morbidity and mortality. Not only is there no generic fluid that will cover all circumstances, but no ideal fluid exists for any specific situation. Further research comparing 0.9% saline to a balanced salt solution may reveal a type of fluid that is the closest to being ideal.

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