[Dr.Vad]

The ideal fluid for resuscitation has not been established. The three-to-one rule has been applied to the classification of hemorrhage to establish a baseline for guiding therapy [36], and use of crystalloid (Ringers lactate or normal saline) is recommended by the American College of Surgeons [4]. Although resuscitative end-points are similar when using Ringers lactate or normal saline, metabolic hyperchloremic acidosis has been reported when infusing large volumes of normal saline (>10 l) [35].
Colloidal solutions, such as albumin and hetastarch (6% hydroxyethyl starch in 0.9% NaCl), can be administered to increase circulatory volume rapidly. Although it is beyond the scope of this review to enter the crystalloid versus colloid fray, we should note that the use of albumin solutions in the initial resuscitation stages has not proven to be more effective than crystalloid [37-39]. A meta-analysis of 26 prospective randomized trials (including a total of 1622 patients) revealed an increased absolute risk for death of 4% when colloids were used for resuscitation [40].

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