Equilibrio hidroelectrolitico

Review
The long-standing debate over whether colloid or crystalloid solutions make better volume-expanders for surgical and trauma patients has taken a surprising turn, with allegations of researchfraud engulfing a well-known proponent of certain colloids.

Joachim Boldt, MD, PhD, until recently of the Klinikum der Stadt Ludwigshafen in Germany, has been accused of having fabricated entirestudies, failing to obtain IRB approval for studies that were conducted, and forging names of co-authors on manuscript submissions.

A report by the state medical board in the German region ofRheinland-Pfalz backed up the charges, leading to his dismissal from the hospital, European newspapers reported.

This week, nearly 90 of Boldt's published papers were retracted by editors of 16 surgeryand anesthesiology journals because of the failure to document IRB approval. News reports indicated that Boldt may face fines or imprisonment because research on human subjects without IRB approval is acrime in Germany.

Because Boldt's research was so extensive and frequently cited, practice guidelines on fluid management are now being revisited.

The Association of Surgeons of Great Britainand Ireland, for example, has removed its guideline on the topic from its website. A statement indicated that the references to Boldt's work would be removed, and the guideline recommendations willundergo "a thorough review ... to determine whether any adjustments to them are needed."

Such guidelines have generally indicated that physicians can use either colloid or crystalloid solutions,although in the U.S., crystalloids have generally been favored.

A 2004 guideline from the American Thoracic Society on use of colloids in critically ill patients urged caution because of possiblyhigher rates of adverse effects, especially with synthetic colloids such as hydroxyethyl starches (HES), which were a major focus of Boldt's publications.

Surgeons and anesthesiologists contacted by...