{"title":"Crystalloids, colloids, blood and blood products and substitutes","authors":"Patrick J Neligan","doi":"10.1016/j.mpaic.2024.12.005","DOIUrl":null,"url":null,"abstract":"<div><div>Intravenous fluids are a core therapy in critical care and perioperative practice. Although most fluids that we use today are very similar to those of the mid 20<sup>th</sup> Century, our understanding of the physiology of the cardiovascular system, the microcirculation and the extravascular space has evolved considerably. In modern practice, thought should be given to the distribution of stressed and unstressed blood volume, the glycocalyx and the gelatinous interstitial matrix. All of these components change dynamically in volume depleted states.</div><div>In the dehydrated patient, if given slowly, most intravenous fluid remains in the circulation. However, if delivered rapidly, much of the it extravasates into the interstitium causing hydraulic damage and oedema.</div><div>In general, isotonic balanced crystalloid solutions should be used in preference to 0.9% saline for resuscitation, and hypotonic crystalloid solutions, containing generous quantities of potassium, should be used for maintenance. There is minimal indication for colloidal products in modern medicine, with the exception of human albumin solution in liver disease. Blood products are indicated as the primary resuscitation tool in haemorrhagic shock.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 3","pages":"Pages 175-180"},"PeriodicalIF":0.2000,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Anaesthesia and Intensive Care Medicine","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1472029924002698","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Intravenous fluids are a core therapy in critical care and perioperative practice. Although most fluids that we use today are very similar to those of the mid 20th Century, our understanding of the physiology of the cardiovascular system, the microcirculation and the extravascular space has evolved considerably. In modern practice, thought should be given to the distribution of stressed and unstressed blood volume, the glycocalyx and the gelatinous interstitial matrix. All of these components change dynamically in volume depleted states.
In the dehydrated patient, if given slowly, most intravenous fluid remains in the circulation. However, if delivered rapidly, much of the it extravasates into the interstitium causing hydraulic damage and oedema.
In general, isotonic balanced crystalloid solutions should be used in preference to 0.9% saline for resuscitation, and hypotonic crystalloid solutions, containing generous quantities of potassium, should be used for maintenance. There is minimal indication for colloidal products in modern medicine, with the exception of human albumin solution in liver disease. Blood products are indicated as the primary resuscitation tool in haemorrhagic shock.
期刊介绍:
Anaesthesia and Intensive Care Medicine, an invaluable source of up-to-date information, with the curriculum of both the Primary and Final FRCA examinations covered over a three-year cycle. Published monthly this ever-updating text book will be an invaluable source for both trainee and experienced anaesthetists. The enthusiastic editorial board, under the guidance of two eminent and experienced series editors, ensures Anaesthesia and Intensive Care Medicine covers all the key topics in a comprehensive and authoritative manner. Articles now include learning objectives and eash issue features MCQs, facilitating self-directed learning and enabling readers at all levels to test their knowledge. Each issue is divided between basic scientific and clinical sections. The basic science articles include anatomy, physiology, pharmacology, physics and clinical measurement, while the clinical sections cover anaesthetic agents and techniques, assessment and perioperative management. Further sections cover audit, trials, statistics, ethical and legal medicine, and the management of acute and chronic pain.