Crystalloid or colloid for resuscitation. Are we any the wiser?

Introduction In the past year there has been an escalation of the age-old crystalloid–colloid debate as a result of the publication of several systematic reviews assessing the effect of various colloids versus various crystalloids on mortality. In 1998, an excess mortality of 4% for the colloid resuscitated patients was claimed for various colloids versus various crystalloids in various clinical scenarios [1]. A further systematic review, published in July 1998 from the same lead author, compared mortality in patients receiving human albumin solutions with those who did not and concluded there was a 6% excess mortality in the albumin group [2]. In 1999, a systematic review claimed no difference in mortality for colloid or crystalloid resuscitation where various colloids were compared to various crystalloids in various hypovolaemic insults [3]. This commentary seeks to analyse the systematic reviews critically and relate their findings to clinical practice in the modern intensive care unit.