EDITORIAL Pendulum swings again: crystalloid or colloid fluid therapy?

Since the 1980s, evidence has been accumulating that survi-vors of major surgery generate a higher postoperative cardiac output than non-survivors, and that achieving a supra-normal oxygen delivery to the body’s major organs (DO2, nor-mally.1000 ml O2 min 21) in the perioperative period, using supplementary i.v. fluids combined with inotropes, could improve survival in high-risk patients.1 – 3 A recent Cochrane Systematic Review identified 31 studies (including 5292 participants) that studied the perioperative in-crease in global blood flow to explicit defined goals.4 Of these, 28 were single-centre and included,200 participants. One large multi-centre studydominated the results of the analysis.5 While no difference in mortality was found, colloid-based, indi-vidualized goal-directed therapy (GDT) was associated with