Colloids versus crystalloids for fluid resuscitation in critically ill patients

 

Characteristics of included studies [ordered by study ID]

Boldt 1986

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Methods	Randomised controlled trial, using sealed opaque envelopes. Information on allocation concealment was obtained on contact with the authors. Blinding and loss to follow up not mentioned.
Participants	55 patients undergoing elective aorta-coronary bypass surgery. Exclusion criteria were ejection fraction < 50% and LVEDP > 15 mmHg.
Interventions	300ml 20% human albumin solution (n = 15). 500ml 3% hydroxyethyl starch (n = 13). 500ml 3.5% gelatin (n = 14). No colloid (n = 13).
Outcomes	Haemodynamic variables were measured. Deaths not reported.
Notes	Follow up until discharge from intensive care.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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Boldt 1993

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Methods	Randomised controlled trial. Allocation concealment by sealed opaque envelopes (information from author). Blinding and loss to follow up not mentioned.
Participants	75 males undergoing elective aortocoronary bypass grafting, who had a pulmonary capillary wedge pressure of less than 5 mmHg after induction of anaesthesia.
Interventions	5% albumin (n = 15). 6% HES, mean molecular weight 450,000 (n = 15). 6% HES, mean molecular weight 200,000 (n = 15). 3.5% gelatin (n = 15). No colloid (n = 15). Fluid used through operation and on intensive care post-op.
Outcomes	Deaths not reported, author confirmed there were no deaths.
Notes	Follow up to 1 day.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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Boldt 2001

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Methods	Randomised controlled trial, using a closed-envelope system.
Participants	100 patients undergoing major abdominal surgery.
Interventions	Ringer's lactate (n = 25). 6% HES, mean molecular weight 200kDa, degree of substitution 0.5 (n = 25). 6% HES, mean molecular weight 130kDa, degree of substitution 0.4 (n = 25). 4% modified fluid gelatin, molecular weight 35kDA (n = 25).
Outcomes	Deaths. Orthostatic problems. Haemodynamics and laboratory data. Fluid input and output. Costs.
Notes	Follow-up period unclear.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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Boutros 1979

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Methods	Randomised controlled trial ("randomly divided"). Method of allocation concealment not described. Blinding not mentioned. No loss to follow up.
Participants	24 people undergoing major operative procedures on the abdominal aorta.
Interventions	Albumin in 5% dextrose (n = 7). 5% dextrose and Ringer's lactate (n = 8). 5% dextrose in 0.45% saline (n = 9). Allocated fluids were used on admission to ICU, following surgery, guided by PAWP. Whole blood also given if clinically needed.
Outcomes	Deaths reported.
Notes	Follow up to discharge from hospital.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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Bowser-Wallace 1986

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Methods	Quasi-randomised controlled trial (allocation by alternation). Blinding not mentioned. No loss to follow up.
Participants	Admitted for burns of 30% or more. Age range 5 months to 21 years. Excluded if already given more than half calculated daily requirement before reaching hospital.
Interventions	2ml/kg/%burn Ringer's lactate over 24 hrs, then 0.5ml plasmanate/kg/%burn over 24 hrs plus 5% dextrose (n = 19). 2ml/kg/%burn hypertonic lactated saline over 24 hrs, then 0.6ml/kg/%burn hypertonic lactated saline over 24 hrs plus oral Haldane's solution (n = 19). IV fluids stopped at 48 hrs (n = 19).
Outcomes	Deaths reported. Fluid and electrolytes given, weight, haematocrit.
Notes	Follow up to 5 days.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	No	Inadequate.

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Brunkhorst 2008

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Methods	Multicenter, randomised control study. Blinding not mentioned. Use of a two-by-two factorial, open label study design.
Participants	Critically ill patients with severe sepsis or septic shock of at least 18 years of age. Excluded if onset of symptoms commenced more than 24 hours before admission to the ICU, if the symptoms commenced more than 12 hours after onset in the ICU or if patient had received more than 1000 ml of HES in the 24 hours before randomisation.
Interventions	1. 10% Pentastarch/HES (200/0.5) (n = 262) 2. Modified Ringer's Lactate (n = 275)
Outcomes	Deaths reported at 28 and 90 days. 90 day mortality rate was cited as it marked the end of the follow-up period.
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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Chavez-Negrete 1991

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Methods	Randomised controlled trial (allocation by "random numbers"). Blinding not mentioned. No loss to follow up.
Participants	Adults admitted to an emergency room with acute gastrointestinal haemorrhage, systolic blood pressure 90 mmHg or less for up to 1 hr and normal electrocardiograph. Excluded if pregnant or had renal, cardiac or neurological disease.
Interventions	Initial infusion of 250ml 7.5% saline/6% Dextran 60 given IV (16 patients) or intraosseous (n = 10). Initial IV infusion of 250ml Ringer's lactate (n = 23). Resuscitation continued with red cells, 0.9% saline and Dextran 40 according to clinical judgement.
Outcomes	Death. Haemodynamic variables.
Notes	Follow up to 24 hours.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear.

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Cifra 2003

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Methods	Quasi-randomised controlled trial (allocation by alternation). Allocation concealment not reported. Blinding not reported. No loss to follow up.
Participants	27 children with dengue shock syndrome. Exclusion criteria included: Other severe infection, protein-deficient abnormalities, bleeding diathesis, patients who have been given multiple plasma substitutes.
Interventions	6% Haes-Steril (n = 11). Ringer's Lactate (n = 16). One patient from group 1 and three from group 2 were excluded because they needed inotropic support and multiple plasma substitute.
Outcomes	Duration of control of shock. Recurrence of shock. Length of ICU stay. Death not reported as an outcome but they reported that 4 patients died.
Notes	Length of follow up not reported but all outcomes were in-hospital.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Not used

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Dawidson 1991

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Methods	Randomised controlled trial (allocation by drawing a card from a deck). Blinding not mentioned. No loss to follow up.
Participants	Adults undergoing elective abdominal aortic surgery. No exclusions mentioned.
Interventions	3% Dextran 70 in Ringer's lactate (n = 10). IV Ringer's lactate (n = 10). Fluid used during and for 24 hrs after operation, guided by haemodynamic variables.
Outcomes	Death. Volume transfused, weight change, haemodynamic variables.
Notes	Follow up to discharge from hospital.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	No	Inadequate

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Dehne 2001

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Methods	Randomised controlled trial; allocation by sealed envelope assignment.
Participants	60 male patients (of American Society of Anesthesiologists physical status 1 or 2) scheduled for middle ear surgery.
Interventions	Lactated Ringer's solution (n = 15). 6% HES: molecular weight 200kD, degree of substitution 0.5 (n = 15). 6% HES: molecular weight 200kD, degree of substitution 0.60-0.66 (n = 15). 6% HES: molecular weight 450kD, degree of substitution 0.7 (n = 15).
Outcomes	Deaths not stated but 'all' patients discharged 10-14 days after surgery; therefore no deaths. Central venous pressure. Urine output. Blood osmolality. Urine osmolality.
Notes	Follow up two days.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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Eleftheriadis 1995

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Methods	Patients "randomizedly distributed". Blinding not mentioned. Unable to assess loss to follow up.
Participants	Participants were undergoing coronary artery bypass surgery.
Interventions	6% hydroxyethyl starch. 3.5% gelatin. Ringer's lactate. Allocated fluid was used in the post-operative period only guided by mean arterial pressure.
Outcomes	Deaths were not reported. Haemodynamic variables.
Notes	Follow up period unspecified.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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Ernest 1999

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Methods	Randomised controlled trial, allocation concealment not described. No blinding. No loss to follow up mentioned.
Participants	Patients with a clinical diagnosis of sepsis.
Interventions	5% albumin (n = 9). 0.9% saline (n = 9). Volume of infusion guided by PAWP.
Outcomes	Haemodynamic variables and volume measurements. Deaths not reported.
Notes	Follow up to immediately after infusion.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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Evans 1996

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Methods	Quasi-randomised trial (allocation by day of the week). Blinding not mentioned. No loss to follow up.
Participants	Aged 16 or more, admitted with trauma to an emergency centre within 2 hours after injury, only crystalloid as a pre-hospital infusion. Excluded if had underlying illness likely to affect clotting.
Interventions	IV haemaccel (n = 11). IV Ringer's lactate (n = 14). Fluid was used until vital signs were stable.
Outcomes	Deaths from author. Clotting variables.
Notes	Follow up period unspecified.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	No	Inadequate

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Evans 2003

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Methods	Randomised controlled trial. Allocation concealment not reported. Blinding methods not reported. Loss to follow up not reported.
Participants	55 patients undergoing primary unilateral total hip replacement. Exclusion criteria were pre-existing defect in platelet function or on aspirin that could not be stopped for 2 weeks prior to the operation.
Interventions	4.5% Albumin (n = 13). Gelofusine (n = 14). Haemaccel (n = 14). 0.9% Saline (n = 14).
Outcomes	Haemostatic parameters. Death not reported.
Notes	Length of follow up not reported but all outcomes were in-hospital.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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Fries 2004

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Methods	Randomised controlled trial. (Patients "randomly" received crystalloid or colloids.) Method of allocation concealment not reported. Blinding not reported. Loss to follow up not reported.
Participants	60 patients undergoing knee replacement surgery. Exclusion criteria were contraindication for regional anaesthesia, known allergies or haemostatic disorders.
Interventions	HES (n = 20). Modified gelatin (n = 20). Ringer's solution (n = 20). Groups 1 and 2 also received a basis of Ringer's solution infusion.
Outcomes	Coagulation parameters. Death not reported.
Notes	Length of follow up not reported but all outcomes were in-hospital measures.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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Gallagher 1985

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Methods	Randomised controlled trial. Method of allocation concealment not described. Author contacted - allocation concealment by computerised system - patient details were entered before treatment assignment was revealed. Blinding not mentioned. No loss to follow up.
Participants	Patients after coronary artery bypass graft surgery. Exclusions: patients with significant left main coronary artery stenosis, poor left ventricular function or poor pulmonary function.
Interventions	IV 5% albumin (n = 5). IV 6% hydroxyethyl starch (n = 5). IV Ringer's lactate (n = 5). Fluid used from admission to intensive care post op, guided by PAWP. RBC given if needed. Five patients received 5% albumin. Five patients received lactated Ringer's.
Outcomes	Deaths were not reported. Author contacted and confirmed that there were no deaths in any group. Haemodynamic data.
Notes	Follow up to 1 day.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Yes	Adequate

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Goodwin 1983

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Methods	Randomised controlled trial - assigned by "random numbers table". Method of allocation concealment unclear. Blinding not mentioned. No loss to follow up.
Participants	79 previously healthy young adults admitted with burns. No exclusion criteria reported.
Interventions	2.5% albumin in Ringer's lactate (n = 40). Ringer's lactate (n = 39). Fluids on day 1 guided by haemodynamic variable. On day 2, given at 0.3-0.5ml/kg/%burn, then 5% dextrose.
Outcomes	Deaths reported. Lung water in some. Infections.
Notes	Follow up to discharge from hospital.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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Grundmann 1982

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Methods	Randomised controlled trial. Method of allocation concealment unclear. Blinding not mentioned. No loss to follow up.
Participants	20 people undergoing partial gastrectomy. The average age was 50 years (range 19-84). No exclusion criteria reported.
Interventions	Colloid group received human albumin solution (n = 14). Details of crystalloid were not reported (n = 6). Allocated fluid was continued for 4 days after operation.
Outcomes	Deaths reported. Volumes of fluid given. Haemodynamic variables.
Notes	Follow up to discharge from hospital.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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Guo 2003

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Methods	Randomised controlled trial. Allocation concealment not reported. Blinding not reported. No loss to follow up reported.
Participants	42 patients undergoing elective cytoreductive surgery for ovarian cancer. Exclusion criteria included: preoperative anaemia, allergic response to HES or perioperative administration of cardiovascular agents. 2 patients randomised but excluded because of use of cardiovascular agents.
Interventions	Ringer's Lactate (n = 20). 6% HES (n = 20).
Outcomes	Splanchnic perfusion. Death not reported but in results authors mentioned that "all patients were discharged."
Notes	Follow up to discharge from hospital.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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Hall 1978

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Methods	Quasi-randomised controlled trial (participants were stratified by age, extent of burn and aetiology, and then allocated by alternation). Blinding not mentioned. No loss to follow up.
Participants	Burns covering more than 10% of the body surface (for children), and more than 15% of the body surface (for adults). No exclusions mentioned.
Interventions	120ml/%burn IV 6% Dextran 70 in 0.9% saline over 48 hrs plus oral water or IV 5% dextrose for 'metabolic requirements' (n = 86). 4ml/kg/%burn IV Ringer's lactate over 24 hrs, then 10% of initial body weight of fluid over 24 hrs plus oral water (n = 86).
Outcomes	Death. Fluid given, haemodynamic variables.
Notes	Follow up to discharge from hospital.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	No	Inadequate

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Hartmann 1993

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Methods	Randomised controlled trial (method of allocation unclear). Blinding not mentioned. No loss to follow up.
Participants	Adults undergoing major abdominal surgery. Exclusions: cardiorespiratory dysfunction, uraemia, diabetes, taking steroids, anticoagulants or diuretics.
Interventions	IV Dextran 70 in saline (concentration not given) with 2.5% dextrose (n = 15). IV saline (concentration not given) with 2.5% dextrose (n = 14). Both groups given red cells, plasma, Dextran 70 and crystalloids during the operation as decided by the clinician. Post-operative fluids according to the trial group guided by tissue oxygen tension to the end of resuscitation.
Outcomes	Death not reported. Fluid given, haemodynamic variables.
Notes	Follow up to 7 days.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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Jelenko 1978

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Methods	Randomised controlled trial, method of allocation concealment unclear. Blinding not mentioned. No loss to follow up.
Participants	19 people with burns covering more than 20% of body surface.
Interventions	12.5% albumin in hypertonic saline (240MeQ Na+, 120 MeQ chloride, 120 MeQ lactate), (n = 7). Hypertonic saline (240MeQ Na+, 120 MeQ chloride, 120 MeQ lactate). (n = 5). Ringer's lactate (n = 7). Allocated fluid was used, guided by haemodynamic variables, to the end of resuscitation.
Outcomes	Deaths reported. Haemodynamic variables.
Notes	Follow up to end of resuscitation.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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Karanko 1987

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Methods	Randomised controlled trial. Description of allocation procedure unclear. Blinding not mentioned. No loss to follow up.
Participants	32 adult men scheduled for coronary artery bypass surgery. Exclusions: left ventricular ejection fraction under 40%, abnormal lung function.
Interventions	Colloid group received 6% dextran 70 (n = 14). Ringer's lactate (n = 18). Allocated fluid was used to the end of resuscitation.
Outcomes	Deaths reported. Haemodynamic variables. Lung water.
Notes	Follow up 2 weeks.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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Lang 2001

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Methods	Randomised controlled trial, using a closed-envelope system.
Participants	42 patients scheduled for elective major abdominal surgery.
Interventions	Lactated Ringer's (n = 21). 6% HES, molecular weight 139kD, degree of substitution 0.4 (n = 21).
Outcomes	Deaths. Haemodynamics and laboratory data. Tissue oxygenation. Volume input and output.
Notes	Follow up period unclear.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Yes	Adequate

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Lang 2003

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Methods	Randomised controlled trial. Allocation concealment not clearly reported ("Closed envelope system"). Blinding method not reported ("...treatment in the ICU was performed by physicians who were blinded to the study").
Participants	36 patients undergoing elective major abdominal surgery. Exclusion criteria included:myocardial failure, renal insufficiency, severe pulmonary disease, liver dysfunction, diabetes mellitus, steroid therapy, pre-existing viral or bacterial infection and known allergic reactions to starch preparations.
Interventions	6% HES (n = 18). Ringer's Lactate (n = 18). Additional crystalloid solutions were supplied to equalize insensible fluid loss or as a solvent for drugs in group 1.
Outcomes	Pro- and anti-inflammatory cytokines. All patients survived.
Notes	Length of follow up not reported but all outcomes were in-hospital measures.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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Ley 1990

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Methods	Randomised controlled trial. Method of allocation concealment unclear. Assessment of chest x-ray blinded. No loss to follow up.
Participants	21 people undergoing coronary artery bypass grafting or valve surgery.
Interventions	6% hetastarch up to 1.5L then 5% plasma protein fraction (n = 11). 0.9% saline (n = 10). Allocated fluid was used for post-operative fluid resuscitation.
Outcomes	Deaths were not reported. Pulmonary and peripheral oedema. Haemodynamic variables.
Notes	Follow up to discharge.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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Lowe 1977

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Methods	Randomised controlled trial, allocation by sealed envelopes. Blinding not mentioned. No loss to follow up.
Participants	Participants with serious trauma.
Interventions	25% albumin in Ringer's lactate (n = 77). Ringer's lactate (n = 94). Allocated fluid was used throughout the pre- and intra-operative period.
Outcomes	Deaths reported.
Notes	Follow up to 5 days post-operatively. Data on the 30 participants with chest injuries who were left out of the Lowe 1977 report, but included in Moss 1981, have been included in the meta-analysis.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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Lucas 1978

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Methods	Randomised controlled trial. Randomisation was based on the last digit of each patient's case number.
Participants	52 seriously injured patients.
Interventions	Standard resuscitation regimen ('balanced electrolyte', blood, fresh frozen plasma) plus salt poor albumin, maximum 150g during surgery and 150g per day for the next 5 days (n = 27). Standard resuscitation regimen as above (n = 25).
Outcomes	Deaths reported in some patients.
Notes	In the final report of 94 randomised patients deaths were not reported. However, in this preliminary report of 52 injured patients deaths were reported.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	No	Inadequate

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Maitland 2005

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Methods	Randomised controlled trial. Open label. Random allocation was assigned by the use of sealed cards. No loss to follow up.
Participants	159 children with severe malaria and metabolic acidosis. Exclusion criteria included pulmonary oedema, oedematous malnutrition or papilledema.
Interventions	Severe acidosis 4.5% Albumin (n = 23). 0.9% Saline (n = 26). Moderate acidosis 4.5% Albumin (n = 33). 0.9% Saline (n = 35). Control (n = 33).
Outcomes	Reduction in base deficit. Neurological sequelae. Death reported.
Notes	Length of follow up not reported but all outcomes were in-hospital measures.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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Mattox 1991

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Methods	Quasi-randomised, allocation by alternation. Double-blind. 2 patients excluded from the analysis as code of fluid lost.
Participants	Participants were pre-hospital trauma victims attended to by emergency personnel within an hour of injury, who had systolic blood pressure of 90 mmHg or less and were 16 years or older. 72% of participants had sustained penetrating trauma.
Interventions	250 mL Dextran-70 in 7.5% NaCl (n = 211). 250 mL Ringer's lactate, saline or plasmalyte (n = 211). Allocated fluid was for initial pre-hospital resuscitation only.
Outcomes	Deaths reported.
Notes	Follow up to hospital discharge or transfer.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	No	Inadequate

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Mazher 1998

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Methods	Patients 'randomized'. Blinding of care givers by use of pharmacy prepared solutions. No loss to follow up.
Participants	Patients undergoing elective coronary artery surgery. Exclusions: age over 75, ejection fraction under 35%, creatinine over 135umol/L, ACE inhibitors.
Interventions	5mL/kg polygeline (n = 10). 5mL/kg 7.2% saline (n = 10). Allocated fluid given post-op over one hour. All patients subsequently receive polygeline and red blood cells.
Outcomes	Haemodynamic variables. Death.
Notes	Follow up to discharge from intensive care.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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McNulty 1993

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Methods	Randomised controlled trial. Method of allocation concealment not described. Blinding not mentioned. No loss to follow up.
Participants	Patients following elective cardiopulmonary bypass.
Interventions	5% albumin and cell-saved blood (n = 14). Plasmalyte and cell-saved blood (n = 14). Allocated fluid used as part of fluid volume replacement.
Outcomes	Deaths not reported. Study was designed to look at the effect of protein infusion on the accuracy of a haematocrit measuring device.
Notes	Length of follow up unspecified.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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Metildi 1984

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Methods	Randomised controlled trial. Blinding not mentioned. No loss to follow up.
Participants	Participants were admissions to an intensive care and a trauma unit with adult respiratory distress syndrome and established pulmonary failure. Included both trauma and non-trauma patients.
Interventions	5% salt-poor albumin (n = 20). Ringer's lactate (n = 26). Allocated fluid was used throughout resuscitation, and if an operation was required the allocated fluid was used for volume replacement before and during the operation.
Outcomes	Deaths reported. Haemodynamic variables.
Notes	Follow up to discharge.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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Modig 1983

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Methods	Quasi-randomised controlled trial, allocation by admission date. Blinding not mentioned. No loss to follow up.
Participants	Participants were trauma admissions to an emergency department with a systolic blood pressure of less than 70mmHg. Age range was 20-58 years.
Interventions	Dextran-70 in Ringer's lactate (n = 12). Ringer's lactate (n = 11). Allocated fluids were given as the initial resuscitation fluid on admission to the emergency department, and continued as needed until after the 6th day when major reconstructive surgery was undertaken.
Outcomes	Deaths reported. Development of respiratory distress syndrome.
Notes	Follow up to definitive reconstructive surgery.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	No	Inadequate

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Moretti 2003

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Methods	Randomised controlled trial. Allocation concealment method not clearly reported ("Patients randomized...by using a closed-envelope technique"). Blinding method not clearly reported ("Researchers were unaware of the patient's randomization"). No loss to follow up.
Participants	90 adult patients undergoing major elective general, gynaecological, orthopedic or urologic surgery with an anticipated blood loss > 500 ml. Exclusion criteria included age < 16 years, coagulopathy, renal or hepatic dysfunction and congestive heart failure.
Interventions	Hetastarch-Normal Saline (n = 30). Hetastarch-Balanced Salt (n = 30). Ringer's Lactate (n = 30).
Outcomes	Postoperative nausea and vomiting. Death not reported.
Notes	Follow up to discharge.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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Nagy 1993

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Methods	Randomised controlled trial, contact with author showed it was an open label study. Blinding not mentioned. No loss to follow up.
Participants	Participants were adult admissions to a trauma unit, with measurable systolic blood pressure less than 90 mmHg.
Interventions	Pentastarch in 0.9% NaCl (n = 21). Ringer's lactate (n = 20). Allocated fluid was used throughout resuscitation with the exception that colloid patients received a maximum 4L of pentastarch, after which Ringer's lactate was given.
Outcomes	Deaths were not reported. Haemodynamic variables.
Notes	Follow up to discharge.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	No	Inadequate

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Ngo 2001

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Methods	Randomised controlled trial, opaque envelopes containing only treatment pack number.
Participants	230 children with dengue shock syndrome.
Interventions	Dextran 70 (n = 55). 3% gelatin (n = 56). Lactated Ringer's (n = 55). 'Normal' saline (n = 56).
Outcomes	Initial pulse recovery time. Occurrence of timing and subsequent episodes of shock. Fall in haematocrit. Volume of fluid administered till recovery. Complications. And noted that there were no deaths in any group
Notes	Follow up period unclear.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Yes	Adequate

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Nielsen 1985

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Methods	Randomised controlled trial. Method of allocation concealment not described. Blinding not mentioned. No loss to follow up.
Participants	26 patients admitted for reconstructive surgery of the abdominal aorta.
Interventions	Whole blood, crystalloid plus 80g albumin on the day of the operation, and 20g per day for the next 3 days. Albumin given as 100mL 20% human albumin solution (n = 13). Whole blood and crystalloid, type not specified (n = 13).
Outcomes	Deaths not reported. Author when contacted confirmed that there were no deaths in either group.
Notes	Length of follow up 4 days.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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Pockaj 1994

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Methods	Randomised controlled trial, allocation concealment unclear. Blinding not mentioned. Loss to follow up 18/54 in colloid group, 13/53 in saline group.
Participants	Participants required fluid resuscitation as a result of vascular leak syndrome associated with Interleukin-2 therapy for metastatic cancer.
Interventions	250 mL boluses of 5% albumin in saline (n = 36 reported). 250 mL boluses of 0.9% normal saline (n = 40 reported). Boluses guided by haemodynamic variables. Both groups also received 0.45% saline with 10mmol/L KCl.
Outcomes	Deaths. Toxic effects of chemotherapy. Haemodynamic variables.
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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Prien 1990

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Methods	Randomised controlled trial. Blinding not mentioned. No loss to follow up.
Participants	Participants were undergoing modified Whipple's operation.
Interventions	10% hydroxyethyl starch in 0.9% saline plus plasma protein fraction if requirements > 20mL/kg (n = 6). 20% human albumin solution (n = 6). Ringer's lactate. Allocated fluid was administered intra-operatively only.
Outcomes	Deaths. Intestinal oedema formation.
Notes	Follow up period was unspecified.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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Rackow 1983

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Methods	Randomised controlled trial, allocation concealment unclear. Blinding not mentioned. No loss to follow up.
Participants	Participants were aged 54 to 97, and had any one of the following pre-determined indicators of shock: systolic blood pressure of 90 mmHg or less, a cardiac index of less than 2.2 L./min.m2, a serum arterial lactate greater than 18mg/dl and WP less than 15mmHg.
Interventions	6% hydroxyethyl starch (n = 9). 5% albumin (n = 9). 0.9% saline (n = 8). Allocated fluid was given as needed until the end of resuscitation.
Outcomes	Deaths reported. Fluid balance.
Notes	Follow up to discharge from hospital.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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Rocha e Silva 1994

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Methods	Randomised controlled trial.
Participants	Participants were admissions to the emergency room, with a systolic blood pressure of 90 mmHg or less and were 16 years of age or older.
Interventions	Colloid group received 6% dextran-70 in 7.5% NaCl; crystalloid group received Ringer's lactate. Allocated fluid was used for the first intravenous infusion only.
Outcomes	Death was the main outcome measure, but the data are unpublished.
Notes	Follow up to 30 days. By April 1994, 125 patients had been entered into the study.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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SAFE 2004

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Methods	Randomised controlled trial. Randomisation by minimisation algorithm accessed through secure website.
Participants	Patients aged 18 years and above admitted to closed multidisciplinary intensive care units in 16 tertiary hospitals in Australia over 19-month period.
Interventions	4% albumin (Albumex, CSL) (n = 3499). Normal saline (n = 3501).
Outcomes	Death. Patients with new single or multiple-organ failure. Mean number of days: in ICU, in hospital, on mechanical ventilation, on renal replacement therapy.
Notes	Follow up to 28 days.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Yes	Adequate

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Shah 1977

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Methods	Randomised controlled trial. Allocation by sealed envelope. Blinding not mentioned. No loss to follow up.
Participants	Patients with severe, multiple trauma and a systolic blood pressure of less than 90mmHg. All patients were adults and both sexes were included.
Interventions	5% salt-poor albumin in Ringer's lactate (n = 9). Ringer's lactate (n = 11). Volume infused guided by physiological parameters.
Outcomes	Death reported. Haemodynamic variables.
Notes	Length of follow up not stated.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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Shires 1983

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Methods	Patients 'assigned randomly'. Blinding not mentioned. No loss to follow up.
Participants	People undergoing aortic reconstruction surgery. No exclusion criteria mentioned.
Interventions	Plasmanate (n = 9). Ringer's lactate (n = 9). Allocated fluid used guided by haemodynamic variables until the first postoperative morning. All patients then received 0.45% saline.
Outcomes	Lung water. Haemodynamic variables. Death.
Notes	Follow up to two days post-op.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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Sirieix 1999

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Methods	Patients "randomly assigned". Blinding not described. Two patients excluded after randomisation due to arrhythmias on giving the fluid (both in hypertonic saline group).
Participants	Patients undergoing mitral valve repair. Exclusions: LVEF < 0.4, systolic PAP > 50mmHg, coagulation disorders, creatinine >150mmoL/L, electrolyte imbalance, diabetes, previous atrial fibrillation lasting > 1 year.
Interventions	250mL 7.2% hypertonic saline, 6%HES (n = 8). 250mL 7.2% hypertonic saline (n = 10). 250mL 6% HES (n = 8). Fluid given over 15mins, 1 hour after admission to post-op intensive care.
Outcomes	Haemodynamic variables. Deaths reported. Side effects (2 had severe hypotension in group 2 and 1 in group 1; arrhythmias in 1 patient in group 1, 3 in group 2 and 1 in group 3).
Notes	Follow up to discharge from hospital (all within 10 days).
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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Skillman 1975

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Methods	Randomised controlled trial, allocation concealment unclear. Blinding not mentioned. No loss to follow up.
Participants	Participants were undergoing elective abdominal reconstructive surgery.
Interventions	25% salt-poor albumin 1g/kg and 5% albumin 1L (n = 7). Ringer's lactate. Allocated fluid was given intra-operatively. All patients received crystalloids only for pre-loading before surgery.
Outcomes	Deaths were not reported.
Notes
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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Tollofsrud 1995

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Methods	Randomised controlled trial, allocation by sealed envelopes. Blinding not mentioned. No loss to follow up.
Participants	Participants were adult patients in need of volume replacement during and after coronary artery bypass surgery.
Interventions	Haemaccel (n = 10). Dextran 70 (n = 10). Albumin 40 (n = 10). Ringer's lactate (n = 10). Allocated fluid was used throughout resuscitation.
Outcomes	Deaths reported. Fluid balance.
Notes	Follow up to 48 hours.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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Tollofsrud 1998

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Methods	Randomised controlled trial, allocation by sealed envelope. Described as double blind, no loss to follow up mentioned.
Participants	Patients with three vessel coronary artery disease undergoing elective coronary artery surgery. Exclusions: LVEF < 0.4, ventricular aneurysm, significant arrhythmia, diabetes, renal failure, lung disease.
Interventions	4mL/kg of 75mg/mL hypertonic saline in dextran 70 60mg/mL over 30 mins (n = 10). Same volume and rate of isotonic saline (n = 10). Fluid given just after surgery while still in operating theatre. Ringer's lactate for additional fluid.
Outcomes	Fluid balance. Haemodynamic variables. Deaths not reported.
Notes	Follow up to 48 hours.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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Upadhyay 2004

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Methods	Open label randomised trial. Allocation by sealed envelope. No loss to follow up mentioned.
Participants	60 patients with septic shock aged 1 month to 12 years. Exclusion criteria: age less than one month, multiorgan failure and immunodeficiency states.
Interventions	Normal saline (n = 31). Polymer from degraded gelatin in saline (gelatin) (n = 29).
Outcomes	Haemodynamic data. Death reported.
Notes	Length of follow up not reported but all outcomes were in-hospital measures.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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Vassar 1990

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Methods	Randomised controlled trial, allocation concealment unclear. Double blind study (solutions prepared in identical containers). No loss to follow up.
Participants	Participants were emergency department admissions with trauma and a systolic blood pressure below 80mmHg and were 18 years or older. Pregnant women and people with preexisting cardiac, hepatic or renal disease were excluded.
Interventions	6% dextran 70 in 7.5% saline (n = 23). Ringer's lactate (n = 24). Allocated fluids were given as the initial resuscitation in the emergency department. Additional isotonic crystalloids (Ringer's lactate) were given as needed.
Outcomes	Deaths reported. Haemodynamic variables.
Notes	Follow up to hospital discharge.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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Vassar 1991

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Methods	Randomised controlled trial, allocation by randomised sequence of coded containers. Double blind study. No loss to follow up.
Participants	Participants were pre-hospital trauma cases undergoing helicopter transport to an emergency centre, with a systolic blood pressure of 100mmHg or less and were 18 years or older. Exclusions: preexisting cardiac renal, hepatic or neurological disease. Peripheral oedema.
Interventions	4.2% dextran 70 in 7.5% saline or 6% dextran 70 in 7.5% saline (n = 83). Ringer's lactate (n = 83). Fluids were given as the initial resuscitation fluid in the pre-hospital setting. Supplemental isotonic fluids were given at the discretion of the flight nurses.
Outcomes	Deaths reported. Haemodynamic variables.
Notes	Follow up to discharge. Allocation was to 4.2% dextran-70; to 6% dextran-70; or to crystalloid; for the calculation of the summary effect measure, the two dextran groups are combined.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Yes	Adequate

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Vassar 1993a

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Methods	Randomised controlled blind trial, allocation concealed by random sequence of identical containers. Double blind study. 36 people excluded post randomisation as deemed not to have met eligibility criteria. No loss to follow up.
Participants	Participants, who were undergoing ambulance transport to an emergency centre, had systolic blood pressure 90 mmHg or less, and were 18 years or older. Exclusions: asystolic, undergoing CPR, lack sinus complex on ECG, more than 2 hours after trauma, pregnant, preexisting seizures, bleeding disorder, hepatic, cardiac or renal disease.
Interventions	6% dextran 70 in 7.5% saline (n = 89). 7.5% saline (n = 85). 0.9% saline (n = 84). Participants received 250mL of the allocated fluid in the pre-hospital setting. Additional isotonic crystalloids were given as needed.
Outcomes	Deaths reported. Haemodynamic variables. Trauma scores.
Notes	Follow up was to discharge from hospital.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Yes	Adequate

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Vassar 1993b

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Methods	Randomised controlled trial, allocation concealed by sequential use of coded identical containers. Double blind study. 39/233 patients excluded as deemed not to meet eligibility criteria, unclear from which groups.
Participants	Participants were pre-hospital trauma cases undergoing helicopter transport to an emergency centre, had a systolic blood pressure of 100mmHg or less and were 18 years or older. Exclusions: asystolic, undergoing CPR, lack sinus complex on ECG, more than 2 hours after trauma, pregnant, preexisting seizures, bleeding disorder, hepatic, cardiac or renal disease.
Interventions	12% dextran 70 in 7.5% saline (n = 49). 6% dextran 70 in 7.5% saline (n = 50). 7.5% saline (n = 50). Ringer's lactate (n = 45). Participants received 250mL of the allocated fluid in the pre-hospital setting. Additional isotonic crystalloids were given as needed.
Outcomes	Deaths reported. Haemodynamic variables. Trauma scores and neurological outcome scores.
Notes	Follow up to hospital discharge.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Yes	Adequate

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Verheij 2006

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Methods	Randomised controlled trial. Allocation concealment by "the sealed envelope method". Blinding method not reported. No loss to follow up.
Participants	67 patients with presumed hypovolemia after cardiac and major vascular surgery. Exclusion criteria; age > 79 years and known anaphylactoid reaction to colloids.
Interventions	Saline (n = 16). Gelatin (n = 16). HES (n = 16). Albumin (n = 16).
Outcomes	Haemodynamic data. Death not reported.
Notes	Length of follow up not reported but all outcomes were in-hospital measures.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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Virgilio 1979

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Methods	Allocation "by random number". Blinding not mentioned. No loss to follow up.
Participants	Participants were undergoing abdominal aortic surgery.
Interventions	5% albumin (n = 15). Ringer's lactate (n = 14). Allocated fluid was used during operation for maintenance of pre-defined physiological parameters, and the resuscitation was continued with the allocated fluid until the day following the operation. This was followed by 5% dextrose in half-normal saline, with potassium chloride as needed.
Outcomes	Deaths reported.
Notes	Follow up two and a half weeks.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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Wahba 1996

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Methods	Patients "randomly allocated". Blinding not mentioned. Two patients excluded as they required reoperation for bleeding.
Participants	22 adult patients in need of volume replacement following coronary artery bypass surgery. Exclusions: abnormal left ventricular function, platelet active medication or heparin.
Interventions	Haemaccel (n = 10). Ringer's lactate (n = 10). Allocated fluid was used from the time of admission to intensive care following operation, to the end of resuscitation.
Outcomes	Deaths reported. Pulmonary oedema.
Notes	Follow up to discharge.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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Wills 2005

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Methods	Randomised controlled study. Allocation concealed by specially prepared cardboard containers. Method of blinding not mentioned. No loss to follow up.
Participants	512 children with Dengue shock syndrome aged 2 to 15 years.
Interventions	Children with immoderately severe shock were randomised to the three interventions: Ringer's lactate (n = 128). 6 percent dextran 70 (n = 126). 6 percent hydroxyethyl starch 200/0.5 (n = 129). Children with severe shock were randomized only to either of the two colloids interventions: 6 percent dextran 70 (n = 67). 6 percent hydroxyethyl starch 200/0.5 (n = 62).
Outcomes	Requirement for supplemental intervention with rescue colloid. Time taken to achieve initial cardiovascular stability. Time taken to achieve sustained cardiovascular stability. Volume required. Change in the Hematocrit. Days in hospital. One death reported but not specified in which group.
Notes	Length of follow up not clear.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Yes	Adequate

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Woittiez 1997

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Methods	Randomised controlled trial, allocation concealment by sealed opaque envelopes. No information on blinding or loss to follow up.
Participants	60 patients who had developed hypoalbuminaemia (< 20g/l) after major surgery. 2 patients died after randomisation and before treatment started. They were excluded from the analysis.
Interventions	saline (500ml/24 hr) (n = 16). albumin 20% (300 ml/24h) (n = 15). HES 10% (500ml/24h) for 3 days (n = 27). Aim was to restore colloid osmotic pressure.
Outcomes	Changes in fluid balance, serum albumin, COP and clinical signs of oedema were followed daily. Death rates supplied by the author.
Notes	Length of follow up unspecified.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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Wu 2001

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Methods	Randomised controlled trial. No details given of randomisation method.
Participants	41 adolescent or adult patients in emergency room suffering from shock.
Interventions	4% modified fluid gelatin: succinated gelatin 40g/L, sodium chloride 7g/L, sodium hydroxide 1.36g/L (n = 18). Lactated Ringer's (n = 16).
Outcomes	Death. Haemodynamic variables.
Notes	Not intention-to-treat: five patients who received blood transfusion and two who had surgery within the first hour of resuscitation were dropped from the analysis. Length of follow up not clear.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

---

Younes 1992

---

Methods	Randomised "in a double blind fashion". Blinding by use of similar bottles. No loss to follow up.
Participants	Participants were emergency department admissions, who had a systolic blood pressure of less than 80mmHg and were 19 years and older. Exclusions: pregnant, preexisting cardiac or metabolic disease.
Interventions	6% dextran 70 in 7.5% saline (n = 35). 7.5% saline (n = 35). 0.9% saline (n = 35). Allocated fluid was for initial bolus of 250mL, followed by isotonic crystalloids as needed.
Outcomes	Deaths reported. Fluid balance.
Notes	Follow up to discharge from hospital.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

---

Younes 1994

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Methods	Trial conducted in a "double blind randomised fashion". Blinding by use of coded, identical containers.
Participants	Participants were trauma admissions to the emergency room requiring treatment for haemorrhagic hypovolaemia; all were over 15 years old. Exclusions: pregnant, cardiac or renal failure, cardiac arrest on arrival.
Interventions	6% dextran 70 in 7.5% saline (n = 101). 0.9% saline (n = 111). Allocated fluid was for the first intravenous infusion only.
Outcomes	Deaths reported. Complications.
Notes	Follow up period was 30 days.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

---

Younes 1998

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Methods	Randomised controlled trial, allocation by sealed envelope. Blinding not mentioned, no apparent loss to follow up.
Participants	Trauma patients with systolic blood pressure <90mmHg admitted to the emergency room, with no previous treatment.
Interventions	10% pentastarch (n = 12). 0.9% saline (n = 11). Fluid given in 250mL boluses until systolic blood pressure > 100mmHg.
Outcomes	Deaths reported. No complications reported in either group.
Notes	Follow up to 24 hours.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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Zetterstrom 1981a

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Methods	The patients were randomly divided into two groups. Allocation concealment was by sealed opaque envelopes (information supplied by author). Blinding not mentioned. No loss to follow up.
Participants	Adult patients undergoing elective major abdominal surgery.
Interventions	Standard volume replacement regimen (1L Dextran 70 then up to 4 units of RBC with electrolyte, then whole blood or RBC with plasma; post-op patients were given crystalloids and whole blood) plus 20% human albumin solution 100ml at end of operation, 200-300ml on same day, then 200ml on first post-op day, then 100ml for next 3 days (n = 15). Standard volume replacement regimen as above (n = 15).
Outcomes	Deaths reported. Haemodynamic variables.
Notes	Length of follow up unspecified.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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Zetterstrom 1981b

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Methods	The patients were randomly divided into two groups. Allocation concealment was by sealed opaque envelopes (information supplied by author). Blinding not mentioned. No loss to follow up.
Participants	18 patients who had undergone elective abdominal aortic surgery. No exclusions mentioned.
Interventions	5% human albumin solution (n = 9). Ringer's lactate solution (n = 9). Administration guided by pulmonary arterial occlusion pressure.
Outcomes	Deaths reported. Haemodynamic variables.
Notes	Follow up to discharge from hospital.
Risk of bias
Item	Authors' judgement	Description
Allocation concealment?	Unclear	Unclear

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 COP = colloid osmotic pressure
HES = hydroxyethylstarch
LVEDP = left ventricular end diastolic pressure
LVEF = left ventricular ejection fraction
PAP = pulmonary artery pressure
PAWP = pulmonary artery wedge pressure
RBC = red blood cells
WP = wedge pressure

 

Characteristics of excluded studies [ordered by study ID]

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Study	Reason for exclusion
Artru 1989	Intervention to control intracranial pressure not directed at fluid resuscitation.
Bocanegra 1966	This study contained two quasi-randomised comparisons of colloid with glucose and plasma/saline with saline. In both studies, the control solution was only given IV if the patient was in coma or shock. It was therefore not a reasonable comparison of colloid and crystalloid.
Boldt 1996	All groups received some colloid.
Boldt 2007	Comparison was not between colloids and crystalloids, rather two different colloid solutions.
Bothner 1998	Participants were having minor elective surgery, therefore not considered to be critically ill.
Breheme 1993	Intervention directed at haemodilution, not at volume replacement.
Bueno R 2004	The participants had elective surgery.
Chin 2006	Participants were undergoing elective surgery, therefore not considered to be critically ill.
Golub 1994	Albumin given solely as a nutritional supplement.
Goslinga 1992	Intervention directed at haemodilution, not volume replacement.
Green 2008	Article is a review.
Greenhalgh 1995	Intervention directed at the maintenance of serum albumin levels, not for volume replacement.
Hauser 1980	Cross-over trial.
Ko 2007	Comparison of crystalloids and colloids as preloading solutions.
Krasheninnikov 2007	Not a randomised controlled trial.
Lagonidis 1995	Intervention was pre-loading for coronary artery bypass surgery.
Lobo 2008	Experiment conducted on rabbits.
Marhofer 1999	Trial of fluid for preloading before spinal anaesthesia.
Mittermayr 2007	Patients were undergoing elective surgery.
Mittermayr 2008	Outcome was the change in concentration of tissue-type plasminogen activator.
Niemi 2008	Solutions were used for pump priming.
Nilsson 1980	Albumin given as a nutritional supplement.
Oliviera 2002	The participants had sepsis.
Paton-Gay 2007	The outcome was non-relevant to comparing crystalloids and colloids.
Paul 2003	The participants had elective surgery.
Rehm 2001	Two colloids (albumin and hetastarch) compared.
Steinberg 1989	Cross-over trial.
Tiryakioglu 2008	Patients were undergoing elective surgery and not considered critically ill. Also, the solutions were used as priming solutions.
Tseng 2008	Crystalloid and colloid treatment was not randomised.
Valetova 2007	Patients were randomised depending upon their treatment not prior to treatment.
Vercueil 2006	Article is a review.
Wilkes 2001	One group received saline plus hetastarch; the other received 'balanced' fluid plus hetastarch. Thus, each group received both a colloid and a crystalloid. This conflicts with the purpose our review which compares patients who had one of these with patients who had the other.
Woods 1993	This quasi-randomised trial looked at albumin supplementation in post operative patients, with the aim of maintaining the serum albumin. Since the main aim of giving albumin was not to replace volume, the study was excluded.

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Comparison 1. colloid versus crystalloid (add-on colloid)

---

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

---

 1 deaths

47

Risk Ratio (M-H, Fixed, 95% CI)

Subtotals only

---

1.1 albumin or PPF

23

7754

Risk Ratio (M-H, Fixed, 95% CI)

1.01 [0.92, 1.10]

---

1.2 hydroxyethyl starch

17

1172

Risk Ratio (M-H, Fixed, 95% CI)

1.18 [0.96, 1.44]

---

1.3 modified gelatin

11

506

Risk Ratio (M-H, Fixed, 95% CI)

0.91 [0.49, 1.72]

---

1.4 dextran

9

834

Risk Ratio (M-H, Fixed, 95% CI)

1.24 [0.94, 1.65]

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Comparison 2. colloid and hypertonic crystalloid versus isotonic crystalloid

---

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

---

 1 deaths

9

Risk Ratio (M-H, Fixed, 95% CI)

Subtotals only

---

1.1 albumin or PPF

1

14

Risk Ratio (M-H, Fixed, 95% CI)

0.5 [0.06, 4.33]

---

1.2 hydroxyethyl starch

0

0

Risk Ratio (M-H, Fixed, 95% CI)

Not estimable

---

1.3 modified gelatin

0

0

Risk Ratio (M-H, Fixed, 95% CI)

Not estimable

---

1.4 dextran

8

1283

Risk Ratio (M-H, Fixed, 95% CI)

0.88 [0.74, 1.05]

---

 

Comparison 3. colloid versus hypertonic crystalloid

---

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

---

 1 deaths

3

Risk Ratio (M-H, Fixed, 95% CI)

Subtotals only

---

1.1 albumin or PPF

1

38

Risk Ratio (M-H, Fixed, 95% CI)

7.0 [0.39, 126.92]

---

1.2 hydroxyethyl starch

1

16

Risk Ratio (M-H, Fixed, 95% CI)

Not estimable

---

1.3 modified gelatin

1

20

Risk Ratio (M-H, Fixed, 95% CI)

Not estimable

---

1.4 dextran

0

0

Risk Ratio (M-H, Fixed, 95% CI)

Not estimable

---