Parenteral fluid therapy in septic shock: An evaluation of crystalloid and colloid

A retrospective review of 25 patients with bacteremic shock was undertaken to evaluate and compare the quality of resuscitation with infusion of either crystalloid or colloid solutions. The average improvement in systolic pressure in the crystalloid infusion group was 23 mm of Hg, whereas the colloid group achieved a mean rise in pressure of 48 mm. Colloid was also superior to crystalloid in terms of speed and magnitude of response measured. In the group of 8 patients given colloid, central venous pressure was recorded over the 24-hour infusion period with a mean rise of 8 cm of water produced, vs. 2 cm of water in the crystalloid group. Crystalloid administration aggravated arterial hypoxemia, whereas colloid infusion did not worsen respiratory function. All 25 patients were oliguric or anuric before beginning therapy; adequate urine flow was quickly restored by expanding blood volume alone, with the fusion of a large volume of salt and water unnecessary. Hence, it is concluded that salt solutions should not be given in cases of bacteremic shock, unless clear indications of deficits or continuing losses of sodium and water are present. Excessive sodium administration was an unreliable and ineffective blood volume expander, accentuated hypoalbuminemia, and increased pulmonary shunting and hypoxemia. Prompt blood pressure and central venous pressure elevation, and restoration of urine flow, can be achieved with colloid solution.