Bkj. Wagner et Lf. Damelio, PHARMACOLOGICAL AND CLINICAL CONSIDERATIONS IN SELECTING CRYSTALLOID,COLLOIDAL, AND OXYGEN-CARRYING RESUSCITATION FLUIDS .1., Clinical pharmacy, 12(5), 1993, pp. 335-346
The pharmacologic properties of crystalloid, colloidal, and oxygen-car
rying resuscitation fluids are described, and the findings of clinical
trials of these solutions are discussed. Fluid administration is a fu
ndamental part of resuscitation therapy. Crystalloid solutions supply
water and sodium to maintain the osmotic gradient between the extravas
cular and intravascular compartments. Examples are lactated Ringer's i
njection and 0.9% sodium chloride injection. Colloidal solutions, such
as those containing albumin, dextrans, or starches, increase the plas
ma oncotic pressure and effectively move fluid from the interstitial c
ompartment to the plasma compartment. Oxygen-carrying resuscitation fl
uids, such as whole blood and artificial hemoglobin solutions, not onl
y increase plasma volume but improve tissue oxygenation. Clinically, c
olloidal solutions are generally superior to crystalloids in their abi
lity to expand plasma volume. However, colloids may impair coagulation
, interfere with organ function, and cause anaphylactoid reactions. Cr
ystalloid solutions represent the least expensive option and are less
likely to promote bleeding, but they are more likely to cause edema be
cause larger volumes are needed. Favorable experience with inexpensive
hypertonic crystalloids with improved plasma volume expansion propert
ies may favor a return to resuscitation with crystalloid solutions. Ox
ygen-carrying resuscitation fluids are indicated when the patient has
lost more than 25% of the total blood volume. Tailoring therapy to the
individual patient and close monitoring are essential to safe and eff
ective fluid resuscitation.