FLUID SELECTION: COLLOID VERSUS
CRYSTALLOID
There is still no clear evidence as to what type of fluid
(colloid or crystalloid) should be used for fluid administration.
Finfer and associates randomized almost 7000
patients admitted to the ICU to receive either 4% albumin
or normal saline.124 Mortality from any cause during
the 28-day period was similar in both groups, leading the
authors to conclude that albumin and saline should be
considered equivalent for intravascular volume replacement
in a mixed population of ICU patients. Among colloids,
evidence against the use of hydroxyethyl starch
(HES), because it may increase kidney injury, seems to
exist. When comparing HES versus saline, more patients
in ICUs who were resuscitated with HES required renal
replacement therapy (7% versus 5.8%, P = 0.04) and developed
adverse effects (e.g., pruritus, skin rash) (5.3% versus
2.8%, P < 0.001).125 In patients with severe sepsis, the
use of HES compared with lactated Ringer solution led to
increased 90-day mortality (RR 1.17; 95% CI 1.01 to 1.36,
P = 0.03) and increased requirement for renal replacement
therapy (RR 1.35; 95% CI 1.01 to 1.80, P = 0.04).126
Presently, HES is increasingly becoming viewed as a solution
that should not be administered (see Chapter 61).