Tags

Type your tag names separated by a space and hit enter

Colloids versus crystalloids for fluid resuscitation in critically ill patients.

Abstract

BACKGROUND

Colloid solutions are widely used in fluid resuscitation of critically ill patients. There are several choices of colloid and there is ongoing debate about the relative effectiveness of colloids compared to crystalloid fluids.

OBJECTIVES

To assess the effects of colloids compared to crystalloids for fluid resuscitation in critically ill patients.

SEARCH STRATEGY

We searched the Cochrane Injuries Group's specialised register, CENTRAL, MEDLINE, EMBASE, the National Research Register, Web of Science and MetaRegister. Bibliographies of trials and review articles retrieved were searched. The searches were last updated in December 2006.

SELECTION CRITERIA

Randomised controlled trials (RCTs) of colloids compared to crystalloids, in patients requiring volume replacement. Cross-over trials and trials in pregnant women and neonates were excluded.

DATA COLLECTION AND ANALYSIS

Two authors independently extracted data and rated quality of allocation concealment. Trials with a 'double-intervention', such as those comparing colloid in hypertonic crystalloid to isotonic crystalloid, were analysed separately. The analysis was stratified according to colloid type and quality of allocation concealment.

MAIN RESULTS

We identified 63 eligible trials, 55 of these presented mortality data. COLLOIDS COMPARED TO CRYSTALLOIDS: Albumin or plasma protein fraction - 23 trials reported data on mortality, including a total of 7,754 patients. The pooled relative risk (RR) from these trials was 1.01 (95% confidence interval [95% CI] 0.92 to 1.10). When the trial with poor quality allocation concealment was excluded, pooled RR was 1.00 (95% CI 0.91 to 1.09). Hydroxyethyl starch - 16 trials compared hydroxyethyl starch with crystalloids, n = 637 patients. The pooled RR was 1.05 (95% CI 0.63 to 1.75). Modified gelatin - 11 trials compared modified gelatin with crystalloid, n = 506 patients. The pooled RR was 0.91 (95% CI 0.49 to 1.72). Dextran - nine trials compared dextran with a crystalloid, n = 834 patients. The pooled RR was 1.24 (95% CI 0.94 to 1.65). COLLOIDS IN HYPERTONIC CRYSTALLOID COMPARED TO ISOTONIC CRYSTALLOID: Eight trials compared dextran in hypertonic crystalloid with isotonic crystalloid, including 1,283 randomised participants. Pooled RR was 0.88 (95% CI 0.74 to 1.05).

AUTHORS' CONCLUSIONS

There is no evidence from RCTs that resuscitation with colloids reduces the risk of death, compared to resuscitation with crystalloids, in patients with trauma, burns or following surgery. As colloids are not associated with an improvement in survival, and as they are more expensive than crystalloids, it is hard to see how their continued use in these patients can be justified outside the context of RCTs.

Authors+Show Affiliations

London School of Hygiene & Tropical Medicine, Nutrition & Public Health Intervention Research Unit, Keppel Street, London, UK, WC1E 7HT. pablo.perel@lshtm.ac.ukNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

17943746

Citation

Perel, P, and I Roberts. "Colloids Versus Crystalloids for Fluid Resuscitation in Critically Ill Patients." The Cochrane Database of Systematic Reviews, 2007, p. CD000567.
Perel P, Roberts I. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev. 2007.
Perel, P., & Roberts, I. (2007). Colloids versus crystalloids for fluid resuscitation in critically ill patients. The Cochrane Database of Systematic Reviews, (4), CD000567.
Perel P, Roberts I. Colloids Versus Crystalloids for Fluid Resuscitation in Critically Ill Patients. Cochrane Database Syst Rev. 2007 Oct 17;(4)CD000567. PubMed PMID: 17943746.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Colloids versus crystalloids for fluid resuscitation in critically ill patients. AU - Perel,P, AU - Roberts,I, Y1 - 2007/10/17/ PY - 2007/10/19/pubmed PY - 2008/1/18/medline PY - 2007/10/19/entrez SP - CD000567 EP - CD000567 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 4 N2 - BACKGROUND: Colloid solutions are widely used in fluid resuscitation of critically ill patients. There are several choices of colloid and there is ongoing debate about the relative effectiveness of colloids compared to crystalloid fluids. OBJECTIVES: To assess the effects of colloids compared to crystalloids for fluid resuscitation in critically ill patients. SEARCH STRATEGY: We searched the Cochrane Injuries Group's specialised register, CENTRAL, MEDLINE, EMBASE, the National Research Register, Web of Science and MetaRegister. Bibliographies of trials and review articles retrieved were searched. The searches were last updated in December 2006. SELECTION CRITERIA: Randomised controlled trials (RCTs) of colloids compared to crystalloids, in patients requiring volume replacement. Cross-over trials and trials in pregnant women and neonates were excluded. DATA COLLECTION AND ANALYSIS: Two authors independently extracted data and rated quality of allocation concealment. Trials with a 'double-intervention', such as those comparing colloid in hypertonic crystalloid to isotonic crystalloid, were analysed separately. The analysis was stratified according to colloid type and quality of allocation concealment. MAIN RESULTS: We identified 63 eligible trials, 55 of these presented mortality data. COLLOIDS COMPARED TO CRYSTALLOIDS: Albumin or plasma protein fraction - 23 trials reported data on mortality, including a total of 7,754 patients. The pooled relative risk (RR) from these trials was 1.01 (95% confidence interval [95% CI] 0.92 to 1.10). When the trial with poor quality allocation concealment was excluded, pooled RR was 1.00 (95% CI 0.91 to 1.09). Hydroxyethyl starch - 16 trials compared hydroxyethyl starch with crystalloids, n = 637 patients. The pooled RR was 1.05 (95% CI 0.63 to 1.75). Modified gelatin - 11 trials compared modified gelatin with crystalloid, n = 506 patients. The pooled RR was 0.91 (95% CI 0.49 to 1.72). Dextran - nine trials compared dextran with a crystalloid, n = 834 patients. The pooled RR was 1.24 (95% CI 0.94 to 1.65). COLLOIDS IN HYPERTONIC CRYSTALLOID COMPARED TO ISOTONIC CRYSTALLOID: Eight trials compared dextran in hypertonic crystalloid with isotonic crystalloid, including 1,283 randomised participants. Pooled RR was 0.88 (95% CI 0.74 to 1.05). AUTHORS' CONCLUSIONS: There is no evidence from RCTs that resuscitation with colloids reduces the risk of death, compared to resuscitation with crystalloids, in patients with trauma, burns or following surgery. As colloids are not associated with an improvement in survival, and as they are more expensive than crystalloids, it is hard to see how their continued use in these patients can be justified outside the context of RCTs. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/17943746/Colloids_versus_crystalloids_for_fluid_resuscitation_in_critically_ill_patients_ L2 - https://doi.org/10.1002/14651858.CD000567.pub3 DB - PRIME DP - Unbound Medicine ER -