Crystalloids or Colloids for the Treatment of Hypovolemia?

Abstract

Blood volume is a critical factor in maintaining hemodynamic equilibrium and tissue oxygenation. Intravascular volume is regulated very closely by means of several complex mechanisms, for which the onset of action varies widely. In some situations, such as acute bleeding, sepsis or with the use of certain drugs, the body must withstand absolute or relative changes in blood volume that cannot be immediately compensated for by the regulatory mechanisms. In these situations, the main goal of volume therapy is to temporarily increase plasma volume until the body's own mechanisms can correct the hypovolemia.Treatment of hypovolemia has changed significantly in recent years. In the past, fresh frozen plasma (FFP) or its equivalent was long the volume expander most commonly used. Now, indications for FFP are limited to the correction of some hemostatic disorders. A by‐product of this legitimate change in practice was increased use of human albumin. Because of the financial consequences of this strategy, several consensus conferences have issued recommendations on the best indications for the use of various plasma volume expanders.Despite these recommendations, the choice of the appropriate agent in the treatment of hypovolemia has not yet been settled. The debate on crystalloids versus colloids continues, along with a debate on the choice of colloid.