Pro/con clinical debate: do colloids have advantages over crystalloids in paediatric sepsis?

Despite decades of resuscitating patients with intravenous fluids in intensive care units, it is somewhat surprising that very little consensus exists regarding the type of fluid physicians should choose. Factors that influence decisions are often local culture or politics, hospital administrators, history (i.e. 'I've always done it this way') and budgets, as opposed to strong evidence. In the present issue of Critical Care we are presented with compelling arguments for and against the administration of colloids (as opposed to crystalloids) in paediatric sepsis. One point that appears to be clear is that the ideal choice of intravenous fluid goes beyond the simple haemodynamic effect. As such, in the future, clinicians will need to consider other factors when making their decision. In addition, large-scale quality randomised studies are desperately needed to guide clinicians.