Fluid Resuscitation for Trauma Patients: Crystalloids Versus Colloids

Abstract

Controversy regarding the role of colloids in the resuscitation of trauma patients has persisted for the past century without a clear resolution. Recently, the early treatment goals of traumatic hypovolemic shock have changed with an emphasis on minimal intravenous fluid administration and the avoidance of over-resuscitation. While some clinicians see a role for colloids in this model, others have become wary as evidence mounts against the efficacy and safety of hydroxyethyl starch and human albumin in critically ill patients. We reviewed the history and fundamentals of the crystalloid versus colloid debate and explored the relevant findings from the prominent non-trauma literature with attention to their applicability in the trauma population. Critical appraisal of the trauma-specific colloid literature is offered with a focus on study design and practical utility. Finally, we offer recommendations about the rational selection of fluids for clinicians who treat these challenging patients.