Background
The utility of providing volume expansion with colloids and their relative use in comparison to crystalloids has been studied extensively for decades [7, 25, 26]. First introduced in the 1940s, the first human protein isolated for clinical use was isooncotic (4-5%) human albumin [27, 28]. After this, other type of colloid solutions available for volume expansion became available in the 1970s, first with hydroxyethyl starches (HES), followed by other types of synthetic colloids [26, 29].
Since their inception, volume expansion with synthetic colloids have been studied extensively in the ICU through a number of well-designed randomized controlled trials, systematic reviews and meta-analyses [30-33]. These studies demonstrate that resuscitation in the ICU with artificial colloids is associated with poorer patient outcomes and increased costs when compared with crystalloids [30, 31, 34-37]. In contrast, the literature investigating resuscitation with natural colloids (i.e. human albumin) suggests fluid therapy with human albumin may be superior to crystalloids in certain patient populations [19, 20, 38-41].