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There are few issues in critical care medicine that have a less clearly defined standard of care than the intravenous fluid choice for resuscitation. Natural colloids (such as albumin) became popular during the Second World War when there was a need to develop a portable, easily stored, blood substitute. Early successes led to widespread use and a multibillion dollar industry. It is not surprising given the large demand, high costs and potential adverse effects of natural colloids that synthetic colloids have emerged. In the present article, two groups of clinical investigators remind us of the controversies surrounding the use of synthetic colloids.

Pro/con clinical debate: Hydroxyethylstarches should be avoided in septic patients.