End of Colloid Era

Abstract

The need for fluid resuscitation, or replacing blood volume is to maintain adequate organ perfusion. Options include colloids such as albumin or hydroxyl ethyl starch and crystalloids such as normal saline or lactated Ringer’s solution. One often cited advantage of using colloids that less volume is needed to produce the desired effect Safety and cost are two major arguments against the use of colloids, along with the lack of evidence for benefit over crystalloids in many patient populations. Recently, findings have suggested that intravenous fluids may be harmful if given in excess (quantitative toxicity) and that some may be more harmful than others (qualitative toxicity), particularly for patients who already have AKI. Recent clinical trials have investigated hydroxyl ethyl starch solutions and found worrying results for the renal community. Colloids can be distinguished as being synthetic (gelatins, dextrans, and starches) or non-synthetic (derived from plasma, hereinafter referred to as albumin as the predominant available form). Each type is associated with several real or hypothetical risks. For example, synthetic colloids have been associated with co-agulopathy, anaphylactoid reactions, and end-organ damage, whereas albumin is derived from pooled plasma collection, and thus carries the potential risk of infection. Low serum albumin levels have been associated with poor survival in critically ill patients, and hypo proteinemia is a licensed indication for albumin therapy. Intravenous solutions consume a substantial portion of pharmacy budgets, with crystalloids being less expensive than colloids, and albumin the most costly.