Fluid resuscitation after severe trauma injury : U-shaped associations between tetrastarch dose and survival time or frequency of acute kidney failure

[Solutions for Fluid Treatment and Outcome - an Update]

Fluid therapy is one of the most frequently used medical interventions with the aim of normalizing the fluid balance. A decisive criterion for the efficiency of fluid or volume replacement is the functionality of the glycocalyx, a thin endothelial glycoprotein layer. Its solidity is an essential factor for fluid exchange and transport from the vascular system to the tissue. The recently described revised Starling principle extends the understanding considerably. From a clinical point of view, fluid treatment should aim for timely euvolemia without inducing relevant side effects. Both crystalloid and natural or synthetic colloidal solutions are available. In the case of crystalloid solutions, the so-called balanced solutions seem to be associated with fewer side effects. If the vascular barrier is intact, colloid solutions have a higher volume effect, but may have significant side effects limiting their use. At least in Europe, some synthetic colloids shall therefore no longer be used in critically ill patients. In contrast, treatment with albumin 20% in hypalbuminemic patients with cardiovascular disease leads to a reduced incidence of acute kidney injury and has also been associated with other clinical benefits. To what extent future, individualized therapeutic approaches employing colloids will influence the outcome is currently speculative.