Swedish practice routines for fluid therapy are considerably changing]

The optimal fluid therapy for plasma volume support at major surgical procedures and in the treatment of critically ill patients has been a matter of considerable controversy during the last few years. The impact of the ongoing debate on Swedish routines has been assessed from a detailed questionnaire sent to all operation (OP) and intensive care units (ICU) in Sweden (n=130) in September 2004. Response was obtained from 92% of the units. It was found that major changes in fluid treatment regimes had occurred in recent years. In spite of the anti-colloid debate in the 1990s the continued use of colloids was evident. The use of albumin was reduced while that of other colloids had increased. Dextran was no longer the dominating colloid since a majority of the departments reported a switch to hydroxyethyl starch (HES). The switch was based on recent information on the advantages and disadvantages of the various products available. Gelatin was only marginally used since it was no longer available on the market. The fluid treatment profile documented on the basis of the responses to the questionnaire agreed well with the recent sale figures of albumin and artificial colloids. A restrictive fluid therapy at surgical procedures is recently advocated based on administration of colloid but only a rather limited volume of crystalloid. Some caution in the application of such a fluid therapy approach seems justified. More liberal fluid administration has recently been found rather to improve recovery after laparoscopic surgery.