DEBAT KRISTALOID VS KOLOID

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THANK U REVIL FOR THE CHANCE, I WILL CONTINUE
THE PRESENTATION.
SO IN THIS PART, WE WILL SEE THE DEBATE BETWEEN
KRISTALOID VS COLLOID. THIS DEBATE CAME FROM 3
EVALUATIONS FROM 3 DIFFERENT SOURCE OF
JOURNAL, SO YOU CAN SEE THE ADVANTAGES AND
DISSADVANTAGES FROM THIS 2 TYPES OF FLUIDS
RESCUSCITATION .

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SO THE 1st EVALUATION CAME The Saline versus
Albumin Fluid Evaluation (SAFE), CAME FROM JURNAL
WITH TITLE A comparison of albumin and saline for
fluid resuscitation in the intensive care unit. SO IN
THIS OBSERVATION , THEY USED 2 TYPES OF FLUIDS ,
ONE IS SALINE FORM CRYSTALOID AND THE OTHER IS
ALBUMIN FROM COLLOID.
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TRANSLETE :
- WHEN THEY TRY TO COMPARED THIS TWO KINDS OF
FLUIDS, THEY FOUND THAT EITHER ALBUMIN OR NS,
BOTH ARE EFFECTIVE AND CLINICALLY EQUIVALENT
TO BE USED AS RESUSCITATION FLUIDS
- WE CAN UNDERLINE THIS PART, THAT THEY USED
ALBUMIN WITH A LOWER DOSAGE THAN NS (1 : 1.4) L

SO THEY FOUND THE RESULTS , WHEN THEY TRY TO

USE THIS TWO TYPES OF FLUIDS IN TRAUMA
PATIENTS, IN THIS CASE THIS PATIENT NEED MORE
THAN 10 PACKET OF RED BLOOD CELLS AND
UNDERWENT DAMAGE CONTROL STRATEGY ( DCS ) DCS, THEY FOUND
THAT PERMISSIVE HYPOTENSION PATIENT WITH HTS (
HYPERTONIC SALINE, Involved less fluid
requirements, reduced 30-day mortality, increased
urine output, and reduced risk of acute respiratory
distress syndrome, sepsis, and organ failure compared
to standard resuscitation with isotonic crystalloids )
( AS WE KNOW BEFORE, CRYSTALLOID CAN BE
DIVIDED INTO 3 TYPES OF FLUIDS, HYPOTONIC,
ISOTONIC AND HYPERTONIC )
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SO THE 2ND EVALUATION CAME FROM
Colloids Versus Crystalloids for the Resuscitation of
the Critically Ill (CRISTAL), CAME FROM
JURNAL WITH TITLE Crys vs HES  ]
Hydroxyethyl starch or saline for fluid resuscitation in
intensive care. ( 2012 )

THIS TIME THEY TRY TO COMPARE COLLOIDS SUCH AS

( GELATIN, DEXTRANS, HYDROXYETHYL STARCHES ,
OR 4% OR 20% OF ALBUMIN ) WITH CRYSTALOID
( SUCH AS ISOTONIC OR HYPERTONIC SALINE OR LR
SOLUTION.

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THE RESEARCHES FOUND THERES NO DIFFERENT

BETWEEN THESE TWO FLUIDS IN 28-DAY MORTALITY,
THE NEEDED OF RENAL REPLACEMENT THEREPAHY,
POSSIBILITY OF ORGAN FAILURE AND NUMBER OF
HOSPITAL DAYS. MORTALITY RATE IN 90 DAYS LOWER
IN COLLOIDS, BUT THIS STATEMENT STILL NEEDED
MORE EVALUATION.
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SO THE 3RD EVALUATION CAME FROM Crystalloid VS

Hydroxyethyl Starch Trial (CHEST), THIS IS CAME
FROM 3 DIFFERENT JOURNAL SOURCES , BUT IN THIS
PPT WE WILL USE ONLY THE LATEST JOURNAL,
NAMED Analysis of colloids versus crystalloids
in critically ill, trauma and surgical patients.

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SO THE RESEARCHERS FOUND THAT USING

Hydroxyethyl starch (HES) CAN increased
renal failure, increased the need for renal-
replacement therapy and also increase the
mortality ( but they just did this observation
only in critically ill patients with sepsis. ) so we
don’t know what will happen if this observation
made under other conditions of patients.
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REKOMENDASI
NEXT , WE WILL DISCUSS ABOUT THE
RECOMMENDATION, BUT WE WILL NOT CHOOSE
WHICH ONE IS THE BEST RECOMMENDATION FOR THE
RESUSCITATION . BUT IN THIS PART WE WILL SHOW
YOU GUYS, THE PLUS AND MINUS AND THE SPECIAL
CONDITION FROM THE USE OF CRYSTALLOID AND
COLLOID
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CRYSTALOID
 - GENERALLY, FOR CRYSTALOID IS MUCH
AVAILABLE AND CHEAPER THAN COLLOID , AND
ALSO GIVE A GOOD RESULTS IN USE FOR TBI AND
FOR THE 1ST RESUSCITATTION OF TRAUMA
PATIENTS.
- HYPERTONIC SALINE SOLUTION ( HTS ), IS VERY
USEFULL IN patients with BRAIN edema, TBI or
massive hemorrhage requiring DAMAGE
CONTROL STRATEGY ( DCS ).
- IN LR , THE L – ISOMER CAUSES less inflammation,
immune dysfunction , and ALSO mortality in
critically ill patients . LR ALSO is recommended
fluid of choice in hemorrhagic shock patients.

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COLLOID
- Colloids remain intravascular longer,SO IT
CAN rapidly expand plasma volume, and WE
CAN GET THE GOALS OF RESUSCITATION
THERAPHY quickly with less volume than IF
WE USE THE crystalloids.
- Colloid IS VERY recommended when patients
cannot tolerate TOO MUCH crystalloid volumes .
- Albumin displays renoprotection.
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SO NEXT, WE WILL SHOW YOU THE ADVANTAGES OF

NEW GENERATION OF GELATINS, WHICH THIS IS
CAME FROM COLLOID. BEFORE THIS, WE ALREADT
COMPARED BETWEEN 2 DIFFERENT FLUIDS, SO IN
THIS PART WE WILL SEE THE COMPARISON OF
GELATIN WITH OTHER COLOID FLUIDS.

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- SO BASICALLY, Gelatin has a low molecular weight

and is cheaper than albumin and other synthetic
colloids , WHICH IS It CAN BE excreted more
quickly by the kidneys and causes less kidney
damage than HES.
- Gelatin Has No Upper Infused Volume Limit and a
lower Risk of Dilutional Coagulopathy IF WE
COMPARED IT WITH HES and Dextran.
- FOR EXAMPLE, GELATIN BINDING WITH POLYGELINE ,
IN INDIA IS used for hypovolemic patients.
BECAUSE Polygelin has a half-life of 4-6 hours,
relatively short compared to other types of
colloids, so it is easily excreted in the urine.
- HOWEVER, further research is needed to prove the
safety of Polygelin.

OKAY THAT’S ALL FROM ME , NEXT, THE

PRESENTATION WILL BE CONTINUED BY
BIMBIM.