The Colloid Crystalloid Debate: Are We Asking the Right Question?

SUMMARY Controversy remains over the best resuscitation fluid (colloid or crystalloid) to use in hypovolemic patients. Most randomized clinical trials done to address this issue were conducted in critically ill patients with mortality as their primary endpoint. Unfortunately these studies were insufficiently powered to detect a difference. Many recent meta‐analyses suffer from limitations that include: dated studies, poor blinding, marked heterogeneity, and disparate therapeutic goals. The type of resuscitation fluid may have little impact on mortality. A properly designed clinical trial that would detect a difference in mortality would be burdensome on limited resources. The effect of these differing fluid types on the quality of a patient's postoperative recovery, as it relates to nausea, vomiting, edema, and pain, may be a more meaningful endpoint for investigation. This review presents the findings of recent meta‐analyses and addresses some common limitations of these reviews. Data on the quality of postoperative recovery with differing fluid regimens is presented, and their effect on renal function and coagulation profiles is examined. The emphasis on the quality of postoperative recovery with the potential to reduce the length of stay shouldn't be minimized. Perhaps the time has come to design clinical trials that study the impact of IV fluids on patient recovery during their hospital stay, rather than mortality.