This is not the most recent version of the article. View current version (16 MAR 2011)

Intervention Review

You have free access to this content

Colloids versus crystalloids for fluid resuscitation in critically ill patients

  1. Pablo Perel1,*,
  2. Ian Roberts1,
  3. Mia Pearson2

Editorial Group: Cochrane Injuries Group

Published Online: 8 JUL 2009

Assessed as up-to-date: 29 SEP 2008

DOI: 10.1002/14651858.CD000567.pub3

Database Title

Additional Information

How to Cite

Perel P, Roberts I, Pearson M. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD000567. DOI: 10.1002/14651858.CD000567.pub3.

Author Information

  1. 1

    London School of Hygiene & Tropical Medicine, Cochrane Injuries Group, London, UK

  2. 2

    c/o Cochrane Injuries Group, London, UK

*Pablo Perel, Cochrane Injuries Group, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. pablo.perel@lshtm.ac.uk.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 8 JUL 2009

SEARCH

ARTICLE TOOLS

This is not the most recent version of the article.View current version (16 Mar 2011)

Summary (63K)Standard (401K)Full (449K)
 

Background

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms

Fluid resuscitation for hypovolaemia is a mainstay of the medical management of critically ill patients, whether as a result of trauma, burns, major surgery or sepsis. Although recent studies (Bickell 1994) have suggested that the timing of volume replacement deserves careful consideration, when it comes to selecting the resuscitation fluid, clinicians are faced with a range of options. At one level the choice is between a colloid or crystalloid solution. Colloids are widely used, having been recommended in a number of resuscitation guidelines and intensive care management algorithms (Armstrong 1994; Vermeulen 1995).

The US Hospital Consortium Guidelines recommend that colloids are used in haemorrhagic shock prior to the availability of blood products, and in non-haemorrhagic shock following an initial crystalloid infusion. A 1995 survey of US academic health centres, however, found that the use of colloids far exceeded even the Hospital Consortium recommendations (Yim 1995). Surveys of burn care in the US (Fakhry 1995) and in Australia (Victorian DUAC 1991) found that the use of colloids for resuscitation varied without a set pattern.

The choice of fluid has considerable cost implications. Volume replacement with colloids is considerably more expensive than with crystalloids. Clinical studies have shown that colloids and crystalloids have different effects on a range of important physiological parameters. Because of these differences, all-cause mortality is arguably the most clinically relevant outcome measure in randomised trials comparing the two fluid types.

 

Why it is important to do this review

Although there have been previous meta-analyses of mortality in randomised trials comparing colloids and crystalloids (Bisonni 1991; Velanovich 1989), neither of these satisfy the criteria that have been proposed for scientific overviews (Oxman 1994), and they predate most of the trials that have been conducted using synthetic colloids, and hypertonic crystalloid solutions. The purpose of this systematic review is to identify and synthesise all available unconfounded evidence of the effect on mortality in critically ill patients of colloids compared to crystalloids for volume replacement.

 

Objectives

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms

To assess the effects on mortality of using colloids compared to crystalloids, during fluid resuscitation in critically ill patients.

 

Methods

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms
 

Criteria for considering studies for this review

 

Types of studies

Controlled trials in which participants were randomised to treatment groups (colloid or control) on the basis of random allocation. As the comparison between fluid type was in terms of effects on mortality, we excluded randomised cross-over trials.

 

Types of participants

Critically ill patients (excluding neonates) who required volume replacement. We included patients who were critically ill as a result of trauma, burns, were undergoing surgery, or had other critical conditions such as complications of sepsis.

We excluded pre-operative elective surgical patients.

 

Types of interventions

We considered the following colloids: Dextran 70, hydroxyethyl starches, modified gelatins, albumin or plasma protein fraction.

There is overlap between albumin given for volume replacement and albumin given as a nutritional supplement, and many patients with a critical illness have low serum albumin. Where the trial was of total parenteral nutrition with or without albumin, we excluded it. We included trials where the albumin was given as part of volume replacement guided by colloid osmotic pressure or albumin levels.

The control group received crystalloid (isotonic or hypertonic) for fluid replacement. We included trials in which both groups received blood.

We excluded trials of fluids used for other purposes. For example, we excluded trials of pre-loading in preparation for elective surgery, and trials in patients undergoing fluid loading before cardiopulmonary bypass.

 

Types of outcome measures

The principal outcome measure was mortality from all causes, assessed at the end of the follow-up period scheduled for each trial.

 

Search methods for identification of studies

The searches were not restricted by date, language or publication status.

 

Electronic searches

We searched the following electronic databases:

  • Cochrane Injuries Group Specialised Register (searched 30 Sept 2008)
  • CENTRAL (The Cochrane Library 2008, Issue 3)
  • MEDLINE (1966 to September 2008)
  • PubMed (searched 30 September, last three months)
  • EMBASE (1980 to September 2008)
  • ISI Web of Knowledge (1970 to September 2008)
  • National Research Register (2006, Issue 4)
  • Controlled Trials metaRegister (www.controlled-trials.com) (searched 30 Sept 2008)

The search strategy can be found in Appendix 1.

 

Searching other resources

We checked the reference lists of all identified trials and review articles, and contacted the trialists to identify any studies that may have been missed.

 

Data collection and analysis

 

Selection of studies

We independently examined titles, abstracts, and keywords of citations from electronic databases for eligibility. We obtained the full text of all relevant records and independently assessed whether each met the pre-defined inclusion criteria. We resolved disagreement by discussion.

 

Assessment of risk of bias in included studies

We scored allocation concealment as described by Higgins 2008, assigning 'No' to poorest quality and 'Yes' to best quality (the presence of solutions in identical containers was only taken to mean adequate concealment if the fluid containers were used sequentially).

  • Yes = trials deemed to have taken adequate measures to conceal allocation (that is, central randomisation; serially numbered, opaque, sealed envelopes; or other description that contained elements convincing of concealment).
  • Unclear = trials in which the authors either did not report an allocation concealment approach at all or reported an approach that did not fall into one of the other categories.
  • No = trials in which concealment was inadequate (such as alternation or reference to case record numbers or to dates of birth).

We collected but did not score information on blinding and loss to follow up.

 

Data synthesis

As a result of comments on the previous version of this review, we have stratified trials by type of fluid rather than type of original injury.

We calculated relative risks (RRs) and 95% confidence intervals (95% CI) for each study using a fixed-effect model. We then inspected each comparison visually for evidence of heterogeneity and performed a Chi2 test. If there was no evidence of heterogeneity (visually or with a P value < 0.1) the trials were pooled within each type of fluid, but not combined between type of fluid.

We then excluded trials with allocation concealment judged as inadequate and repeated the calculations.

 

Results

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms
 

Description of studies

See: Characteristics of included studies; Characteristics of excluded studies.

We identified 65 trials meeting the inclusion criteria for study design, participants and interventions. We were able to obtain mortality data for 56 of these. We have reported details of the included trials in the 'Characteristics of included studies' table.

Reasons for exclusion of trials were: the use of a cross-over design, testing a resuscitation algorithm, giving the control group oral fluids, the intervention being directed to the maintenance of serum albumin levels, for haemodilution, for fluid loading and for the reduction of intracranial pressure (see 'Characteristics of excluded studies' table).

Of the 56 trials with data on deaths, the quality of allocation concealment was adequate in seven trials and unclear in most of the others.

There were 60 comparisons of colloids and crystalloids (add-on colloid), nine comparisons of colloid in hypertonic crystalloid with isotonic crystalloid, and three comparisons of colloid with hypertonic crystalloid.

 

Risk of bias in included studies

In general, the design of studies was not well reported. This is reflected in the number of unclear scores given for allocation concealment. We also collected information on blinding and loss to follow up. Blinding was not well reported and loss to follow up was generally small. The characteristics for each trial are listed in the 'Characteristics of included studies' table.

 

Effects of interventions

 

Colloids compared to crystalloids

 

Albumin or plasma protein fraction

Twenty-three trials reported data on mortality, including a total of 7754 patients. The pooled relative risk (RR) was 1.01 (95% confidence interval (95% CI) 0.92 to 1.10). When we excluded the trial with poor quality allocation concealment (Lucas 1978), pooled RR was 1.00 (95% CI 0.91 to 1.09).

 

Hydroxyethyl starch

Seventeen trials compared hydroxyethyl starch with crystalloids, including a total of 1172 randomised patients. The pooled RR was 1.18 (95% CI 0.96 to 1.44).

 

Modified gelatin

Eleven trials compared modified gelatin with crystalloid, including a total of 506 randomised patients. The pooled RR was 0.91 (95% CI 0.49 to 1.72).

 

Dextran

Nine trials compared dextran with a crystalloid, including a total of 834 randomised patients. The pooled RR was 1.24 (95% CI 0.94 to 1.65).

 

Colloids in hypertonic crystalloid compared to isotonic crystalloid

One trial compared albumin and hypertonic saline with isotonic crystalloid. The RR of death was 0.50 (95% CI 0.06 to 4.33).

Eight trials compared dextran in hypertonic crystalloid with isotonic crystalloid, including 1283 randomised patients. The pooled RR was 0.88 (95% CI 0.74 to 1.05).

 

Colloids in isotonic crystalloid compared to hypertonic crystalloid

Three trials compared colloids in isotonic crystalloid with hypertonic crystalloid. In two of these, where the colloid was either gelatin or starch, there were no deaths in either group. In the remaining trial, with 38 patients, there was a RR of death of 7.00 (0.39 to 126.93) for use of colloid, based on three deaths in the treatment group and none in the control group.

 

Discussion

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms

This systematic review synthesises the evidence from RCTs comparing colloid and crystalloid fluid resuscitation across a wide variety of clinical conditions. The review has been updated and extensively revised to take into account the comments made since it was first published. In particular, several commentators pointed out that it is inappropriate to combine effect estimates from studies of different colloids. For example, it was argued that large molecular weight colloids such as hydroxyethyl starch may be better retained in the vascular compartment than albumin and gelatins, and would therefore be more likely to show a favourable effect on mortality (Gosling 1998). In response to these concerns, the review has been stratified by type of colloid. However, the pooled relative risks fail to show a mortality benefit for resuscitation with any type of colloid.

There was a trend towards a favourable effect on mortality for colloids in hypertonic crystalloid, compared to isotonic crystalloids. Nevertheless, the results are compatible with the play of chance.

Common to all meta-analyses, this systematic review may have included studies whose interventions and patient characteristics are sufficiently incomparable that the calculation of a summary effect measure may be questioned. The resuscitation regimen differed between trials. Some trials randomised participants to an initial quantity of colloid or crystalloid, and then proceeded with some form of standard resuscitation for all participants. Other trials resuscitated with the allocated fluid to pre-determined end-points, either resuscitation end-points, or in the case of trauma, until corrective surgery. In addition, the type of colloid or crystalloid, the concentration, and the protocol to determine the quantity of fluid varied. Despite these differences, all participants were in need of volume replacement, and we believe that this variation in the intervention would have an impact on the size of the effect, rather than on its direction.

As regards the effects of albumin versus crystalloid, most of the information (as indicated by the weighting in the meta-analysis) was provided by the SAFE trial (SAFE 2004). The SAFE trial used central randomisation with a minimisation algorithm to ensure balance on known potential confounders. Blinding was assured through the use of specially designed masking cartons and specially designed and manufactured administration sets. The trial authors report that the effectiveness of the blinding was confirmed in a formal study before the trial was initiated. In brief, this was a well-conducted, high-quality trial. There were 726 deaths (20.9%) in the albumin-treated group and 729 deaths (21.1%) in the saline-treated group (RR of death 0.99; 95% CI 0.91 to 1.09). Although even this large trial was unable to confirm or refute the possibility of a modest benefit or harm from albumin, it has provided some reassurance that any hazard from albumin, if indeed there is any, is unlikely to be as extreme as was suggested by the results from the previously published (now here updated) meta-analysis of much smaller trials. The pooled RR for death with albumin in this updated meta-analysis is now 1.02 (95% CI 0.93 to 1.11). It is important to note that the effect estimate from the SAFE trial is entirely consistent with the results of previous trials of albumin in hypovolaemia and there is no significant heterogeneity (I2 = 0%, P = 0.46).

The results of this updated meta-analysis have important policy implications. There is still no evidence that colloids are superior to crystalloids as a treatment for intravascular volume resuscitation in critically ill patients. Importantly, the SAFE trial also provided no evidence of any other clinical advantages from using albumin. It also debunked the belief, from pathophysiological inference, that very large volumes of crystalloid must be administered to reach the same resuscitation end-points as can be achieved using much smaller volumes of colloid. In the SAFE trial, the ratio of albumin administered to saline administered was approximately 1:1.4. Colloids, in particular albumin, are considerably more expensive than crystalloids, and albumin is a blood product and so carries at least a theoretical infectious disease risk. The economic opportunity cost of ongoing colloid use, particularly albumin use, is likely to be considerable and for this reason its ongoing use in this context is unjustified.

 

Authors' conclusions

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms

 

Implications for practice

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

 
Implications for research

Future trials may need to concentrate on specific subgroups of patients to identify people who may benefit from colloids rather than crystalloids.

 

Acknowledgements

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms

We acknowledge the contribution of Phil Alderson, Frances Bunn, Paul Chinnock and Gillian Schierhout, who were authors of earlier versions of this review.

We would like to acknowledge the Intensive Care National Audit and Research Network in London, for assistance with identification of trials for this review.

We thank Dr. Frank M. Brunkhorst for providing the Supplementary Appendix to the paper Brunkhorst 2008.

 

Data and analyses

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms
Download statistical data

 
Comparison 1. colloid versus crystalloid (add-on colloid)
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
 1 deaths47Risk Ratio (M-H, Fixed, 95% CI)Subtotals only
    1.1 albumin or PPF
237754Risk Ratio (M-H, Fixed, 95% CI)1.01 [0.92, 1.10]
    1.2 hydroxyethyl starch
171172Risk Ratio (M-H, Fixed, 95% CI)1.18 [0.96, 1.44]
    1.3 modified gelatin
11506Risk Ratio (M-H, Fixed, 95% CI)0.91 [0.49, 1.72]
    1.4 dextran
9834Risk Ratio (M-H, Fixed, 95% CI)1.24 [0.94, 1.65]

 
Comparison 2. colloid and hypertonic crystalloid versus isotonic crystalloid
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
 1 deaths9Risk Ratio (M-H, Fixed, 95% CI)Subtotals only
    1.1 albumin or PPF
114Risk Ratio (M-H, Fixed, 95% CI)0.5 [0.06, 4.33]
   1.2 hydroxyethyl starch
00Risk Ratio (M-H, Fixed, 95% CI)Not estimable
   1.3 modified gelatin
00Risk Ratio (M-H, Fixed, 95% CI)Not estimable
    1.4 dextran
81283Risk Ratio (M-H, Fixed, 95% CI)0.88 [0.74, 1.05]

 
Comparison 3. colloid versus hypertonic crystalloid
Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size
 1 deaths3Risk Ratio (M-H, Fixed, 95% CI)Subtotals only
    1.1 albumin or PPF
138Risk Ratio (M-H, Fixed, 95% CI)7.0 [0.39, 126.92]
    1.2 hydroxyethyl starch
116Risk Ratio (M-H, Fixed, 95% CI)Not estimable
    1.3 modified gelatin
120Risk Ratio (M-H, Fixed, 95% CI)Not estimable
   1.4 dextran
00Risk Ratio (M-H, Fixed, 95% CI)Not estimable

 

Appendices

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms
 

Appendix 1. Search strategy

Cochrane Injuries Group’s Specialised Register (searched 30 Sept 2008), PubMed (searched 30 September; last three months), Controlled Trials metaRegister (www.controlled-trials.com) (searched 30 Sept 2008)
colloid* or hydrocolloid* or crystalloid*

MEDLINE 1950 to Sept 2008, EMBASE 1980 to Sept 2008
1.exp Fluid Therapy/
2.exp Rehydration Solutions/
3.exp Colloids/
4.exp Plasma Substitutes/
5.exp Plasma/
6.exp Serum/
7.exp Albumins/
8.exp Isotonic Solutions/
9.exp Hetastarch/
10.((fluid$ or volume or plasma or rehydrat$ or blood or oral) adj3 (replace$ or therap$ or substitut$ or restorat$ or resuscitat$ or rehydrat$)).ab,ti.
11.((fluid$ or volume or plasma or rehydrat$ or blood or oral) adj3 (challenge or perfusion or volume or intravenous or shock)).ti,ab.
12.(isotonic saline solution$ or Blood substitute$ or blood expander$ or plasma volume expander$ or volume expander$).mp. [mp=title, original title, abstract, name of substance word, subject heading word]
13.(colloid$ or crystalloid$ or albumin$ or albumen$ or plasma$ or starch$ or dextran$ or gelofus$ or hemaccel$ or haemaccel$ or hydrocolloid$ or serum$ or hetastarch or isotonic or ringer$ or gelatin$ or gentran$ or pentastarch$ or pentaspan$ or hartman or sodium or potassium or salin$ or hypertonic or hypotonic or hemodilution or haemodilution or ringer lactatae).ti.
14.or/1-13
15.randomi?ed.ab.
16.randomized controlled trial.pt.
17.controlled clinical trial.pt.
18.placebo.ab.
19.clinical trials as topic.sh.
20.randomly.ab.
21.trial.ti.
22.or/15-21
23.humans.sh.
24.22 and 23
25.14 and 24
26.colloid* or hydrocolloid* or crystalloid*
27.exp Colloids/
28.26 or 27
29.25 and 28

ISI Web of Science: Science Citation Index Expanded (SCI-EXPANDED) 1970 to Sept 2008, ISI Web of Science: Conference Proceedings Citation Index- Science (CPCI-S) 1990 to Sept 2008
Topic=(colloid* or hydrocolloid*) AND Topic=(crystalloid*) AND Topic=(randomised OR randomized OR randomly OR random order OR random sequence OR random allocation OR randomly allocated OR at random OR randomized controlled trial* OR controlled clinical trial* OR randomized controlled trial*) NOT Topic=(animal model* OR Animal* OR Animal Experiment* OR Animal disease model* OR Laboratory Animal*)

CENTRAL (The Cochrane Library Issue 3, 2008), National Research Register (to 2006, Issue 4)
#1MeSH descriptor Albumins explode all trees
#2MeSH descriptor Plasma Substitutes explode all trees
#3MeSH descriptor Plasma explode all trees
#4MeSH descriptor Plasma Volume explode all trees
#5MeSH descriptor Fluid Therapy explode all trees
#6MeSH descriptor Colloids explode all trees
#7(#1 OR #2 OR #3 OR #4 OR #5 OR #6)
#8(crystalloid* or ringer* or hartman* or sodium* or potassium* or salin*):ti or (crystalloid* or ringer* or hartman* or sodium* or potassium* or salin*):ab
#9Isotonic saline solution* OR Blood substitute* OR blood expander* OR plasma volume expander* OR volume expander*
#10(colloid* OR crystalloid* OR albumin* OR albumen* OR plasma OR starch* OR dextran* OR gelofus* OR hemaccel* OR haemaccel* OR OR serum OR hetastarch OR isotonic OR ringer* OR gelatin* OR gentran* OR pentastarch* OR pentaspan* OR hartman OR sodium OR potassium OR saline):ti
#11(fluid* OR volume OR plasma OR rehydrat* OR blood OR oral) AND (replace* OR therapy OR substitut* OR restorat* OR resuscitat* OR rehydrat*):ab
#12MeSH descriptor Rehydration Solutions explode all trees
#13MeSH descriptor Serum explode all trees
#14MeSH descriptor Isotonic Solutions explode all trees
#15MeSH descriptor Hetastarch explode all trees
#16(#1 OR #2 OR #2 OR #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14 OR #15)
#17MeSH descriptor Colloids explode all trees
#18colloid* OR crystalloid* OR hydrocolloid*
#19#17 OR #18
#20#16 AND #19

 

What's new

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms

Last assessed as up-to-date: 29 September 2008.

DateEventDescription
17 April 2009New search has been performedApril 2009

An updated search for new trials was conducted in October 2008. One new study was included (Brunkhorst 2008). The analysis, results and discussion sections have been revised accordingly.


 

History

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms

Protocol first published: Issue 4, 1997
Review first published: Issue 4, 1997

DateEventDescription
16 July 2008AmendedConverted to new review format.
1 July 2007New search has been performedAugust 2007
An updated search for new trials was conducted in December 2006. Ten new studies were included (Evans 2003, Cifra 2003, Fries 2004, Guo 2003, Lang 2003, Maitland 2005, Moretti 2003, Upadhyay 2004, Verheij 2006, Wills 2005). The analysis, results and discussion sections have been revised accordingly.


 

Contributions of authors

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms

July 2007
PP and IR examined trials for inclusion or exclusion, reaching agreement by discussion. PP and IR extracted data from the new studies. PP amended the text of the review.

April 2009
IR and MP examined trials for inclusion or exclusion, reaching agreement by discussion. IR and MP extracted data from the new study. MP amended the text of the review. PP edited the final version.

 

Declarations of interest

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms

None known.

 

Sources of support

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Index terms
 

Internal sources

  • Institute of Child Health, University of London, UK.
  • UK Cochrane Centre, NHS R&D Programme, UK.

 

External sources

  • NHS R&D Programme: Mother and Child Health, UK.
  • Cochrane Review Incentive Scheme, Department of Health, UK.

* Indicates the major publication for the study

References

References to studies included in this review

  1. Top of page
  2. Abstract
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Characteristics of studies
  18. References to studies included in this review
  19. References to studies excluded from this review
  20. Additional references
  21. References to other published versions of this review
Boldt 1986 {published data only}
  • Boldt J, von Bormann B, Kling D, Borner U, Mulch J, Hempelmann G. Volume replacement with a new hydroxyethyl starch preparation (3 percent HES 200/0.5) in heart surgery [Volumenersatz mit einem neuen hydroxyathylstarke - praparat (3% HAS 200/0.5) in der herzchirurgie]. Infusionstherapie und Klinische Ernährung 1986;13(3):145-51.
Boldt 1993 {published data only}
  • Boldt J, Knothe C, Zickmann B, Andres P, Dapper F, Hempelmann G. Influence of different intravascular volume therapies on platelet function in patients undergoing cardiopulmonary bypass. Anesthesia and Analgesia 1993;76(6):1185-90.
Boldt 2001 {published data only}
  • Boldt J, Suttner S, Huttner I, Kumle B, Piper S, Krumholz W. Are costs of a crystalloid-based volume replacement regimen lower than of a colloid-based volume replacement stategy. Infusion Therapy and Transfusion Medicine 2001;28:144-9.
Boutros 1979 {published data only}
  • Boutros AR, Ruess R, Olson L, Hoyt JL, Baker WH. Comparison of hemodynamic, pulmonary, and renal effects of use of three types of fluids after major surgical procedures on the abdominal aorta. Critical Care Medicine 1979;7(1):9-13.
Bowser-Wallace 1986 {published data only}
  • Bowser-Wallace BH, Caldwell FT Jr. A prospective analysis of hypertonic lactated saline v. Ringer's lactate-colloid for the resuscitation of severely burned children. Burns 1986;12(6):402-9.
Brunkhorst 2008 {published and unpublished data}
  • Brunkhorst M. Supplementary Appendix. Provided from Dr. Brunkhorst on 26 March, 2009.
  • Brunkhorst M, Engel C, Bloos F. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. New England Journal of Medicine 2008;358:125-39.
Chavez-Negrete 1991 {published data only}
  • Chavez-Negrete A, Lajluf Cruz S, Frati Munari A, Perches A, Argulero R. Treatment of hemorrhagic shock with intraosseus or intravenous infusion of hypertonic saline eextran solution. European Surgical Research 1991;23(2):123-9.
Cifra 2003 {published data only}
  • Cifra HL, Velasco JNJ. A comparative study of the efficacy of 6% Haes-Steril and Ringer's Lactate in the management of dengue shock syndrome 555. Critical Care & Shock 2003;6:95-100.
Dawidson 1991 {published data only}
  • Dawidson IJ, Willms CD, Sandor ZF, Coorpender LL, Reisch JS, Fry WJ. Ringer's lactate with or without 3% dextran-60 as volume expanders during abdominal aortic surgery. Critical Care Medicine 1991;19(1):36-42.
Dehne 2001 {published data only}
  • Dehne MG, Muhling J, Sablotzki A, Dehn K-L, Sucke N, Hempelmann G. Hydroxyethyl starch (HES) does not directly affect renal function in patients with no prior renal impairment. Journal of Clinical Anaesthesia 2001;13(2):103-11.
Eleftheriadis 1995 {published data only}
  • Eleftheriadis S, Sedemund-Adib B, Klotz K-F, Hubner N, Kuppe H. Volume replacement after cardiac surgery: comparison of Ringer, HES 6% and Gelatine 3.5%. Intensive Care Medicine 1995;21(suppl 1):S216.
Ernest 1999 {published data only}
Evans 1996 {published and unpublished data}
  • Evans PA, Garnett M, Boffard K, Kirkman E, Jacobson BF. Evaluation of the effect of colloid (Haemaccel) on the bleeding time in the trauma patient. Journal of the Royal Society of Medicine 1996;89(2):101-4.
Evans 2003 {published data only}
  • Evans PA, Heptinstall S, Crowhurst EC, Davies T, Glenn JR, Madira W, et al. Prospective double-blind randomized study of the effects of four intravenous fluids on platelet function and hemostasis in elective hip surgery. Journal of Thrombosis and Haemostasis 2003;1:2140-8.
    Direct Link:
Fries 2004 {published data only}
  • Fries D, Streif W, Margreiter J, Klingler A, Kuhbacher G, Schobersberger W, et al. The effects of perioperatively administered crystalloids and colloids on concentrations of molecular markers of activated coagulation and fibrinolysis. Blood Coagulation & Fibrinolysis 2004;15:213-9.
Gallagher 1985 {published data only}
  • Gallagher JD, Moore RA, Kerns D, Jose AB, Botros SB, Flicker S, et al. Effects of colloid or crystalloid administration on pulmonary extravascular water in the postoperative period after coronary artery bypass grafting. Anesthesia and Analgesia 1985;64(8):753-8.
Goodwin 1983 {published data only}
  • Goodwin CW, Dorethy J, Lam V, Pruitt BA Jr. Randomized trial of efficacy of crystalloid and colloid resuscitation on hemodynamic response and lung water following thermal injury. Annals of Surgery 1983;197(5):520-31.
Grundmann 1982 {published data only}
Guo 2003 {published data only}
  • Guo XY, Xu ZH, Ren HZ, Luo AL, Huang YG, Ye TH. Effect of volume replacement with hydroxyethyl starch solution for blood loss on splanchnic oxygenation in patients undergoing cytoreductive surgery for ovarian carcinoma. Zhonghua Yi Xue Za Zhi 2003;83:114-7.
Hall 1978 {published data only}
  • Hall K, Sorensen B. The treatment of burn shock. Scandinavian Journal of Plastic and Reconstructive Surgery 1973;7:67-73.
  • Hall K, Sorensen B. The treatment of burns shock. In: Vrabec R, Konickova L, Moserova J editor(s). Basic problems in burns. Berlin: Springer-Verlag, 1975.
  • Hall KV, Sorensen B. The treatment of burn shock: results of a 5-year randomized, controlled clinical trial of Dextran 70 v Ringer lactate solution. Burns 1978;5(1):107-12.
Hartmann 1993 {published data only}
  • Hartmann M, Jonsson K, Zederfeldt B. Effects of dextran and crystalloids on subcutaneous oxygen tension and collagen accumulation. A randomized study in surgical patients. European Surgical Research 1993;25:270-7.
Jelenko 1978 {published data only}
  • Jelenko C 3rd. Fluid therapy and the HALFD method. Journal of Trauma 1979;19(11 Suppl):866-7.
  • Jelenko C 3rd, Solenberger RI, Wheeler ML, Callaway BD. Shock and resuscitation. III. Accurate refractometric COP determinations in hypovolemia treated with HALFD. JACEP 1979;8(7):253-6.
  • Jelenko C 3rd, Wheeler ML, Callaway BD, Divilio LT, Bucklen KR, Holdredge TD. Shock and resuscitation. II: Volume repletion with minimal edema using the "HALFD"(Hypertonic Albuminated Fluid Demand) regimen. JACEP 1978;7(9):326-33.
  • Jelenko C 3rd, Williams JB, Wheeler ML, et al. Studies in shock and resuscitation, I: use of a hypertonic, albumin-containing, fluid demand regimen (HALFD) in resuscitation. Crit Care Med 1979;7(4):157-67.
Karanko 1987 {published data only}
  • Karanko M, Klossner J, Laksonen V. Restoration of volume by crystalloid versus colloid after coronary artery bypass: haemodynamics, lung water, oxygenation and outcome. Critical Care Medicine 1987;15:559-66.
Lang 2001 {published data only}
  • Lang K, Boldt J, Suttner S, Haisch G. Colloids versus crystalloids and tissue oxygen tension in patients undergoing major abdominal surgery. Anesthesia and Analgesia 2001;93(2):405-9.
Lang 2003 {published data only}
  • Lang K, Suttner S, Boldt J, Kumle B, Nagel D. Volume replacement with HES 130/0.4 may reduce the inflammatory response in patients undergoing major abdominal surgery. Canadian Journal of Anaesthesia 2003;50:1009-16.
Ley 1990 {published data only}
Lowe 1977 {published data only}
  • Lowe RJ, Moss GS, Jilek J, Levine HD. Crystalloid versus colloid in the etiology of pulmonary failure after trauma - a randomized trial in man. Critical Care Medicine 1979;7(3):107-12.
  • Lowe RJ, Moss GS, Jilek J, Levine HD. Crystalloid vs colloid in the etiology of pulmonary failure after trauma: a randomized trial in man. Surgery 1977;1(6):676-83.
  • Moss GS, Lowe RJ, Jilek J, Levine HD. Colloid or crystalloid in the resuscitation of hemorrhagic shock: a controlled clinical trial. Surgery 1981;89(4):434-8.
Lucas 1978 {published data only}
  • Clift DR, Lucas CE, Ledgerwood AM, Sardesai V, Kithier K, Grabow D. The effect of albumin resuscitation for shock on the immune response to tetanus toxoid. Journal of Surgical Research 1982;32:449-52.
  • Johnson SD, Lucas CE, Gerrick SJ, Ledgerwood AM, Higgins R. Altered coagulation after albumin supplements for treatment of oligaemic shock. Archives of Surgery 1979;114:379-83.
  • Lucas CE, Bouwman DL, Ledgerwood AM, Higgins R. Differential serum protein changes following supplemental albumin resuscitation for hypovolemic shock. Journal of Trauma 1980;20(1):47-51.
  • Lucas CE, Weaver D, Higgins RF, Ledgerwood AM, Johnson SD, Bouwman DL. Effects of albumin versus non-albumin resuscitation on plasma volume and renal excretory function. Journal of Trauma 1978;18:565-70.
  • Weaver DW, Ledgerwood AM, Lucas CE, Higgins R, Bouwman DL, Johnson SD. Pulmonary effects of albumin resuscitation for severe hypovolaemic shock. Archives of Surgery 1978;113:387-92.
Maitland 2005 {published data only}
  • Maitland K, Pamba A, English M, Peshu N, Marsh K, Newton C, et al. Randomized trial of volume expansion with albumin or saline in children with severe malaria: preliminary evidence of albumin benefit. Clinical Infectious Diseases 2005;40(4):538-45.
Mattox 1991 {published data only}
  • Maningas PA, Mattox KL, Pepe PE, Jones RL, Feliciano DV, Burch JM. Hypertonic saline-dextran solutions for the prehospital management of traumatic hypotension. American Journal of Surgery 1989;157(5):528-33.
  • Mattox KL, Maningas PA, Moore EE, Mateer JR, Marx JA, Aprahamian C, et al. Prehospital hypertonic saline/dextran infusion for post-traumatic hypotension. The U.S.A. Multicenter Trial. Annals of Surgery 1991;213(5):482-91.
Mazher 1998 {published data only}
  • Mazher R, Samenesco A, Royston D, Rees A. Cardiopulmonary effects of 7.2% saline solution compared with gelatin infusion in the early postoperative period after coronary artery bypass grafting. Journal of Thoracic and Cardiovascular Surgery 1998;115(1):178-87.
McNulty 1993 {published data only}
  • McNulty SE, Sharkey SJ, Asam B, Lee JH. Evaluation of STAT-CRIT Hematocrit Determination in comparison to Coulter and Centrifuge: the effects of isotonic hemodilution and albumin administration. Anesthesia and Analgesia 1993;76:830-4.
Metildi 1984 {published data only}
  • Metildi LA, Shackford SR, Virgilio RW, Peters RM. Crystalloid versus colloid in fluid resuscitation of patients with severe pulmonary insufficiency. Surgery, Gynecology and Obstetrics 1984;158(3):207-12.
Modig 1983 {published data only}
  • Modig J. Advantages of dextran 70 over Ringer acetate solution in shock treatment and in prevention of adult respiratory distress syndrome. A randomized study in man after traumatic-haemorrhagic shock. Resuscitation 1983;10(4):219-26.
  • Modig J. Effectiveness of dextran 70 versus Ringer's acetate in traumatic shock and adult respiratory distress syndrome. Critical Care Medicine 1986;14(5):454-7.
Moretti 2003 {published data only}
  • Moretti EW, Robertson KM, El Moalem H, Gan TJ. Intraoperative colloid administration reduces postoperative nausea and vomiting and improves postoperative outcomes compared with crystalloid administration. Anesthesia and Analgesia 2003;96:611-7.
Nagy 1993 {published data only}
  • Nagy KK, Davis J, Duda J, Fildes J, Roberts R, Barrett J. A comparison of pentastarch and lactated Ringer's solution in the resuscitation of patients with hemorrhagic shock. Circulatory Shock 1993;40(4):289-94.
Ngo 2001 {published data only}
  • Ngo NT, Cao XT, Kneen R, Wills B, Nguyen VM, Nguyen TQ, et al. Acute management of dengue shock syndrome: a randomised double-blind comparison of 4 intravenous fluid regimes in the first hour. Clinical Infectious Diseases 2001;32(2):204-13.
Nielsen 1985 {published data only}
  • Nielsen OM, Engell HC. Extracellular fluid volume and distribution in relation to changes in plasma colloid osmotic pressure after major surgery. A Randomised Study. Acta Chir Scand 1985;151:221-5.
Pockaj 1994 {published data only}
  • Pockaj BA, Yang JC, Lotze MT, Lange JR, Spencer WF, Steinberg SM, et al. A prospective randomized trial evaluating colloid versus crystalloid resuscitation in the treatment of the vascular leak syndrome associated with interleukin-2 therapy. Journal of Immunotherapy 1994;15(1):22-8.
Prien 1990 {published data only}
  • Prein T, Backhaus N, Pelster F, Pircher W, Buente H, Lawin P. Effect of intraoperative fluid administration and colloid osmotic pressure on the formation of intestinal edema during gastrointestinal surgery. Journal of Clinical Anesthesia 1990;2:317-23.
Rackow 1983 {published data only}
  • Haupt, MT, Rackow, EC. Colloid osmotic pressure and fluid resuscitation with hetastarch, albumin, and saline solutions. Critical Care Medicine 1982;10(3):159-62.
  • Kaufman BS, Rackow EC, Falk JL. Fluid resuscitation in circulatory shock. Colloids versus crystalloids. Current Studies in Hematology and Blood Transfusion 1986;53:186-98.
  • Rackow EC, Falk JL, Fein IA, Siegel JS, Packman MI, Haupt MT, et al. Fluid resuscitation in circulatory shock: a comparison of the cardiorespiratory effects of albumin, hetastarch, and saline solutions in patients with hypovolemic and septic shock. Critical Care Medicine 1983;11(11):839-50.
Rocha e Silva 1994 {published data only (unpublished sought but not used)}
  • Rocha e Silva M, Poli de Figueiredo LF. Hypertonic-hyperoncotic saline solution for the treatment of post-traumatic hypotension in the emergency room. The Brazilian multi-center trial. SALT 6. International Conference on Hypertonic Resuscitation, Teton Village. June 2-3 1994.
SAFE 2004 {published data only}
Shah 1977 {published data only}
  • Shah DM, Broner BD, Dutton RE, Newell JC, Powers SR. Cardiac output and pulmonary wedge pressure. Use for evaluation of fluid replacement in trauma patients. Archives of Surgery 1977;112:1161-8.
Shires 1983 {published data only}
Sirieix 1999 {published data only}
  • Sirieix D, Hongnat J-M, Delayance S, D'Attellis N, Vicaut E, Berribi A, et al. Comparison of the acute haemodynamic effects of hypertonic or colloid infusions immediately after mitral valve repair. Critical Care Medicine 1999;27:2159-65.
Skillman 1975 {published data only}
Tollofsrud 1995 {published data only}
  • Tølløfsrud S, Svennevig JL, Breivik H, Kongsgaard U, Ozer M, Hysing E, et al. Fluid balance and pulmonary functions during and after coronary artery bypass surgery: Ringer’s acetate compared with dextran, polygeline, or albumin. Acta Anaesthesiologica Scandinavica 1995;39:671-7.
    Direct Link:
Tollofsrud 1998 {published data only}
  • Tollofsrud S, Noddeland H. Hypertonic saline and dextran after coronary artery surgery mobilises fluid excess and improves cardiorespiratory functions. Acta Anaesthesiologica Scandinavica 1998;42:154-61.
    Direct Link:
Upadhyay 2004 {published data only}
  • Upadhyay M, Singhi S, Murlidharan J, Kaur N, Majumdar S. Randomized evaluation of fluid resuscitation with crystalloid (saline) and colloid (polymer from degraded gelatin in saline) in pediatric septic shock. Indian Pediatrics Indian Pediatrics 2004;42(3):223-31.
Vassar 1990 {published data only}
  • Vassar MJ, Perry CA, Holcroft JW. Analysis of potential risks associated with 7.5% sodium chloride resuscitation of traumatic shock. Archives of Surgery 1990;125(10):1309-15.
Vassar 1991 {published data only}
  • Holcroft JW, Vassar MJ, Turner JE, Derlet RW, Kramer GC. 3% NaCl and 7.5% NaCl/dextran 70 in the resuscitation of severely injured patients. Annals of Surgery 1987;206(3):279-88.
  • Vassar MJ, Perry CA, Gannaway WL, Holcroft JW. 7.5% sodium chloride/dextran for resuscitation of trauma patients undergoing helicopter transport. Archives of Surgery 1991;126(9):1065-72.
Vassar 1993a {published data only}
  • Vassar MJ, Perry CA, Holcroft JW. Prehospital resuscitation of hypotensive trauma patients with 7.5% NaCl versus 7.5% NaCl with added dextran: a controlled trial. Journal of Trauma 1993;34(5):622-32.
Vassar 1993b {published data only}
  • Vassar MJ, Fischer RP, O'Brien PE, Bachulis BL, Chambers JA, Hoyt DB, et al. A multicenter trial for resuscitation of injured patients with 7.5% sodium chloride. The effect of added dextran 70. The Multicenter Group for the Study of Hypertonic Saline in Trauma Patients. Archives of Surgery 1993;128(9):1003-11.
Verheij 2006 {published data only}
  • Verheij J, van Lingen A, Beishuizen A, Christiaans HM, de Jong JR, Girbes AR, et al. Cardiac response is greater for colloid than saline fluid loading after cardiac or vascular surgery. Intensive Care Medicine 2006;32(7):1030-8.
Virgilio 1979 {published data only}
  • Virgilio RW, Rice CL, Smith DE, James DR, Zarins CK, Hobelmann CF, et al. Crystalloid vs. colloid resuscitation: is one better? A randomized clinical study. Surgery 1979;85(2):129-39.
Wahba 1996 {published data only}
  • Wahba A, Sendtner E, Strotzer M, Wild K, Birnbaum DE. Fluid therapy with Ringer’s solution versus Haemaccel following coronary artery bypass surgery. Acta Anaesthesiologica Scandinavica 1996;40:1227-33.
    Direct Link:
Wills 2005 {published data only}
  • Wills BA, Nguyen MD, Ha TL, Dong TH, Tran TN, Le TT, et al. Comparison of three fluid solutions for resuscitation in dengue shock syndrome. The New England Journal of Medicine 2005;353:877-89.
Woittiez 1997 {published and unpublished data}
  • Hondebrink Y, Jeekel L, Oude Nijhuis J, Woittiez AJJ. Restoration of colloid osmotic pressure in hypoalbuminaemic patients. Intensive Care Medicine 1997;23(supp 1):S184.
Wu 2001 {published data only}
  • Wu J, Huang M, Tang G, Kao W, Shih H, Su C, et al. Hemodynamic response of modified fluid gelatin compared with lactated ringer's solution for volume expansion in emergency resuscitation of hypovolemic shock patients: preliminary report of a prospective, randomized trial. World Journal of Surgery 2001;25(5):598-602.
Younes 1992 {published data only}
  • Younes RN, Aun F, Accioly CQ, Casale LP, Szajnbok I, Birolini D. Hypertonic solutions in the treatment of hypovolemic shock: a prospective, randomized study in patients admitted to the emergency room. Surgery 1992;111(4):380-5.
Younes 1994 {published data only}
  • Younes R, Aun F, Ching C, Goldenberg D, Franco M, Miura F, et al. Prognostic factors to predict outcome following the administration of hypertonic/hyperoncotic solution in hypovolaemic patients. Shock 1997;7:79-83.
  • Younes RN, Aun F, Ching C, et al. Prognosis following the administration of hypertonic/hyperoncotic solutions in hypovolemic patients. SALT 6. International Conference on Hypertonic Resuscitation. Teton Village. June 2-3 1994.
Younes 1998 {published data only}
  • Younes R, Yin K, Amino C, Itinoshe M, Rocha e Silva M, Birolini D. Use of pentastarch solution in the treatment of patients with hemorrhagic hypovolemia: randomized phase II study in the emergency room. World Journal of Surgery 1998;22:2-5.
Zetterstrom 1981a {published data only}
  • Zetterstrom H, Hedstrand U. Albumin treatment following major surgery. I. Effects on plasma oncotic pressure, renal function and peripheral oedema. Acta Anaesthesiologica Scandinavica 1981;25:125-32.
Zetterstrom 1981b {published data only}
  • Zetterstrom H. Albumin treatment following major surgery. II. Effects on postoperative lung function and circulatory adaptation. Acta Anaesthesiologica Scandinavica 1981;25:133-41.
    Direct Link:

References to studies excluded from this review

  1. Top of page
  2. Abstract
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Characteristics of studies
  18. References to studies included in this review
  19. References to studies excluded from this review
  20. Additional references
  21. References to other published versions of this review
Artru 1989 {published data only}
  • Artru F, Philippon B, Flachaire E, Peyrieux JC, Boissel JP, Ferry S, et al. A controlled study of Dextran 40: effect on cerebral blood flow and metabolic rates in acute head trauma. Intensive Care Medicine 1989;15(8):499-504.
Bocanegra 1966 {published data only}
  • Bocanegra M, Hinostroza F, Kefalides NA, Markley K, Rosenthal SM. A long-term study of early fluid therapy in severely burned adults. 3. Simultaneous comparison of saline solution alone or combined with plasma. Journal of the American Medical Association 1966;195(4):268-74.
Boldt 1996 {published data only}
  • Boldt J, Heesen M, Padberg W, Martin K, Hempelmann G. The influence of volume therapy and pentoxifylline infusion on circulating adhesion molecules in trauma patients. Anaesthesia 1996;51:529-35.
    Direct Link:
Boldt 2007 {published data only}
  • Boldt J, Schollhorn T, Munchbach J. A total balanced volume replacement strategy using a new balanced hydroxyethyl starch preparation (6% HES 130/0.42) in patients undergoing major abdominal surgery. European Journal of Medicine 2007;24:267-75.
Bothner 1998 {published data only}
  • Bothner U, Georgieff M, Vogt N. Assessment of the safety and tolerance of 6% hydroxyethyl starch (200/0.5) solution: a randomized, controlled epidemiology study. Anesthesia and Analgesia 1998;86:850-5.
Breheme 1993 {published data only}
  • Brehme S, Keysser G, Turowski A, Schmidt HH. Hemorheologic effects of hydroxyethyl starch 200/0.5, dextran 40, oxypolygelatine and full electrolyte solution over 48 hours [Hamorheologische Wirkungen von Hydroxyathylstarke 200/0,5, Dextran 40, Oxypolygelatine und Vollelektrolytlosung uber 48 Stunden]. Zeitschrift für die gesamte innere Medizin und ihre Grenzgebiete 1993;48(10):506-10.
Bueno R 2004 {published data only}
  • Bueno R, Resende AC, Melo R, Neto VA, Stolf NA. Effects of hypertonic saline-dextran solution in cardiac valve surgery with cardiopulmonary bypass. Annals of Thoracic Surgery 2004;77(2):604-11.
Chin 2006 {published data only}
  • Chin Y, Macachor J, Ong KC, Ong BC. A comparison of 5% dextrose in 0.9% normal saline versus non-dextrose-containing crystalloids as the initial intravenous replacement fluid in elective surgery. Anasthesia and Intensive Care 2006;34(5):613-7.
Golub 1994 {published data only}
  • Golub R, Sorrento JJ Jr, Cantu R Jr, Nierman DM, Moideen A, Stein HD. Efficacy of albumin supplementation in the surgical intensive care unit: a prospective, randomized study. Critical Care Medicine 1994;22(4):613-9.
Goslinga 1992 {published data only}
  • Goslinga H, Eijzenbach V, Heuvelmans JH, van de Nes JC, Kurk RM, Bezemer PD. [Individualized hemodilution in acute brain infarct using a 20% albumin solution and physiological saline solution]. Nederlands Tijdschrift voor Geneeskunde 1992;136(49):2422-8.
  • Goslinga H, Eijzenbach V, Heuvelmans JH, van der Laan de Vries E, Melis VM, Schmid-Schönbein H, et al. Custom-tailored hemodilution with albumin and crystalloids in acute ischemic stroke. Stroke 1992;23(2):181-8.
  • Goslinga H, Heuvelmans JH, Schmid Schonbein H. Hemodilution and rehydration in acute ischemic stroke. A preliminary report on the Amsterdam Stroke Study. Acta Medica Austriaca 1991;18(Suppl 1):41-4.
Green 2008 {published data only}
  • Green RS, Hall RI. Con: starches are not preferable to albumin during cardiac surgery: a contrary opinion. Journal of Cardiothoracic and Vascular Anesthesia 2008;22(3):485-91.
Greenhalgh 1995 {published data only}
  • Greenhalgh DG, Housinger TA, Kagan RJ, Rieman M, James L, Novak S, et al. Maintenance of serum albumin levels in pediatric burn patients: a prospective, randomized trial. Journal of Trauma 1995;39(1):67-73; discussion 73-4.
Hauser 1980 {published data only}
  • Hauser CJ, Shoemaker WC, Turpin I, Goldberg SJ. Oxygen transport response to colloids and crystalloids in critically ill surgical patients. Surgery 1980;150(6):811-6.
Ko 2007 {published data only}
  • Ko JS, Kim CS Cho HS, Choi DH. A randomized trial of crystalloid versus colloid solution for prevention of hypotension during spinal or low-dose combined spinal-epidural anesthesia for elective cesarean delivery. International Journal of Obstetric Anesthesia 2007;16(1):8-12.
Krasheninnikov 2007 {published data only}
  • Krasheninnikov SV, Levit AL, Malkova OG. Effect of various colloidal solutions on pulmonary oxygenizing function in patients with acute lung lesion. Anestiziologiia i Reanimatologiia 2007;3:20-2.
Lagonidis 1995 {published data only}
  • Lagonidis D, Magder S. Acute volume loading with colloid vs. crystalloid after coronary artery bypass. Intensive Care Medicine 1992;18:(suppl 2):S225.
Lobo 2008 {published data only}
  • Lobo SM, Orrico SR, Queiroz MM, Contrim LM, Cury PM. Comparison of the effects of the lactated Ringer solution with and without hydroxyethyl starch fluid resuscitation on gut edema during severe splanchnic ischemia. Brazilian Journal of Medical and Biological Research 2008;41(7):634-9.
Marhofer 1999 {published data only}
  • Marhofer P, Faryniak B, Oismuller C, Koinig H, Kapral S, Mayer N. Cardiovascular effects of 6% hetastarch and lactated Ringer's solution during spinal anaesthesia. Regional Anesthesia and Pain Medicine 1999;24:399-404.
Mittermayr 2007 {published data only}
  • Mittermayr M, Streif W, Haas T, Fries D, Velik-Salchner C, Klingler A, et al. Hemostatic changes after crystalloid or colloid fluid administration during major orthopedic surgery: the role of fibrinogen administration. British Journal of Anaesthesia 2007;105(4):905-17.
Mittermayr 2008 {published data only}
  • Mittermayr M, Streif W, Haas T, Fries D, Velik-Salchner C, Klingler A, et al. Effects of colloid and crystalloid solutions on endogenous activation of fibrinolysis and resistance of polymerized fibrin to recombinant tissue plasminogen activator added ex vivo. British Journal of Anaesthesia 2008;100(3):307-14.
Niemi 2008 {published data only}
  • Niemi T, Schramko A, Kuitunen A, Kukkonen S, Suojaranta-Ylinen R. Haemodynamics and Acid-base equilibrium after cardiac surgery: comparison of rapidly degradable hydroxyethyl starch solutions and albumin. Scandinavian Journal of Surgery 2008;97(3):259-65.
Nilsson 1980 {published data only}
  • Nilsson E, Lamke O, Liljedahl SO, Elfstrom K. Is albumin therapy worthwhile in surgery for colorectal cancer?. Acta Chirurgica Scandinavica 1980;146:619-22.
Oliviera 2002 {published data only}
  • Oliviera RP, Weingartner R, Ribas EO, Moraes RS, Friedman G. Acute haemodynamic effects of a hypertonic saline/dextran solution in stable patients with severe sepsis. Intensive Care Medicine 2002;28(11):1574-81.
Paton-Gay 2007 {published data only}
  • Paton-Gay JD, Brindley PG, McDermid RC. Best evidence in critical care medicine: fluid management in acute lung injury: friend or foe?. Canadian Journal of Anesthesia 2007;54(1):73-5.
Paul 2003 {published data only}
  • Paul M, Dueck M, Joachim Herrman H, Holzki J. A randomized, controlled study of fluid management in infants and toddlers during surgery: hydroxyethyl starch 6% (HES 70/0.5) vs lactated Ringer's solution. Paediatric Anaesthesia 2003;13(7):603-8.
    Direct Link:
Rehm 2001 {published data only}
  • Rehm M, Haller M, Orth V, Kreimeier U, Jacob M, Dressel H, et al. Changes in blood volume and hematocrit during acute preoperative volume loading with 5% albumin or 6% hetastarch solutions in patients before radical hysterectomy. Anesthesiology 2001;95(4):849-56.
Steinberg 1989 {published data only}
  • Steinberg B, Kochs E, Bause H, Schulte am Esch J. Effects of low molecular weight hydroxyethyl starch (HES 40) in comparison with Ringer solution on oxygen tension in skeletal muscles of infected patients. Anästhesie, Intensivtherapie, Notfallmedizin 1989;24(6):377-81.
Tiryakioglu 2008 {published data only}
  • Tiryakioglu O, Yildiz G, Vural H, Goncu T, Ozyazicioglu A, Yavuz S. Hydroxethyl starch versus Ringer solution in cardiopulmonary bypass prime solutions (a randomized controlled trial). Journal of Cardiothoracic Surgery 2008;3(45):1-6.
Tseng 2008 {published data only}
  • Tseng M, Hutchinson Y, Kirkpatrick P. Effects of fluid therapy following aneurysmal subarachnoid haemorrhage: a prospective clinical study. British Journal of Neurosurgery 2008;22(2):257-68.
Valetova 2007 {published data only}
  • Valetova VV, Khudenko NV, Sakharova EA, Timerbaev VK. Role of starch preparations in the intraoperative correction of hypovolemia in patients with large-size uterine myomas. Anesteziologiia i Reanimatologiia 2007;2:31-4.
Vercueil 2006 {published data only}
  • Vercueil A, Levett D, Grocott M. Resuscitation fluids in trauma, part II: which fluid should I give?. Trauma 2006;8(2):111-21.
Wilkes 2001 {published data only}
  • Wilkes N, Woolf R, Mutch M, Mallett S, Peache T, Stephens R, et al. The effects of balanced versus saline-based heta-starch and crystalloid solutions on acid-base and electrolyte status and gastric mucosal perfusion in elderly surgical patients. Anaesthesia and Analgesia 2001;93(4):811-6.
Woods 1993 {published data only}

Additional references

  1. Top of page
  2. Abstract
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. History
  14. Contributions of authors
  15. Declarations of interest
  16. Sources of support
  17. Characteristics of studies
  18. References to studies included in this review
  19. References to studies excluded from this review
  20. Additional references
  21. References to other published versions of this review
Armstrong 1994
  • Armstrong RF, Bullen C, Cohen SL, Singer M, Webb AR. Critical Care Algorithms. Oxford: Oxford University Press, 1994.
Bickell 1994
  • Bickell WH, Wall MJ, Pepe PE, Martin R, Ginger VF, Allen MK, et al. Immediate versus delayed resuscitation for hypotensive patients with penetrating torso injuries. New England Journal of Medicine 1994;331:1105-9.
Bisonni 1991
  • Bisonni RS, Holtgrave DR, Lawler F, Marley DS. Colloids versus crystalloids in fluid resuscitation: an analysis of randomized controlled trials. Journal of Family Practice 1991;32(4):387-90.
Fakhry 1995
  • Fakhry SM, Alexander J, Smith D, Meyer AA, Peterson HD. Regional and institutional variation in burn care. Journal of Burn Care and Rehabilitation 1995;16(1):86-90.
Gosling 1998
Higgins 2008
  • Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions. Version 5.0.1 [updated September 2008]. The Cochrane Collaboration, 2008. Available from www.cochrane-handbook.org.
Oxman 1994
Velanovich 1989
Vermeulen 1995
  • Vermeulen LC, Ratko TA, Erstad BL, Brecher ME, Matuszewski KA. A paradigm for consensus. The University Hospital Consortium guidelines for the use of albumin, nonprotein colloid, and crystalloid solutions. Archives of Internal Medicine 1995;155(4):373-9.
Victorian DUAC 1991
  • Subcommittee of the Victorian Drug Usage Advisory Committee. Human albumin solutions: an audit of use in three major metropolitan hospitals. Medical Journal of Australia 1991;154(10):657-60.
Yim 1995
  • Yim JM, Vermeulen LC, Erstad BL, Matuszewski KA, Burnett DA, Vlasses PH. Albumin and nonprotein colloid solution use in US academic health centers. Archives of Internal Medicine 1995;155(22):2450-5.
Summary (63K)Standard (401K)Full (449K)