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Intervention Review

Colloids versus crystalloids for fluid resuscitation in critically ill patients

  1. Pablo Perel*,
  2. Ian Roberts

Editorial Group: Cochrane Injuries Group

Published Online: 16 MAR 2011

Assessed as up-to-date: 29 SEP 2008

DOI: 10.1002/14651858.CD000567.pub4


How to Cite

Perel P, Roberts I. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database of Systematic Reviews 2011, Issue 3. Art. No.: CD000567. DOI: 10.1002/14651858.CD000567.pub4.

Author Information

  1. London School of Hygiene & Tropical Medicine, 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: Edited (no change to conclusions)
  2. Published Online: 16 MAR 2011

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This is not the most recent version of the article. View current version (28 FEB 2013)

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary

Background

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

Objectives

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

Search methods

We searched the Cochrane Injuries Group Specialised Register, CENTRAL (The Cochrane Library 2008, Issue 3), MEDLINE, EMBASE, ISI Web of Science: Science Citation Index Expanded (SCI-EXPANDED), ISI Web of Science: Conference Proceedings Citation Index-Science (CPCI-S), and The Controlled Trials metaRegister (www.controlled-trials.com). Reference lists of relevant studies and review articles were searched for further trials. The searches were last updated in September 2008.

Selection criteria

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

Data collection and analysis

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

Main results

We identified 65 eligible trials; 56 of these presented mortality data.

Colloids compared to crystalloids

Albumin or plasma protein fraction - 23 trials reported data on mortality, including a total of 7754 patients. The pooled relative risk (RR) from these trials was 1.01 (95% confidence interval (95% CI) 0.92 to 1.10). When we excluded the trial with poor quality allocation concealment, pooled RR was 1.00 (95% CI 0.91 to 1.09). Hydroxyethyl starch - 17 trials compared hydroxyethyl starch with crystalloids, n = 1172 patients. The pooled RR was 1.18 (95% CI 0.96 to 1.44). Modified gelatin - 11 trials compared modified gelatin with crystalloid, n = 506 patients. The pooled RR was 0.91 (95% CI 0.49 to 1.72). (When the trials by Boldt et al were removed from the three preceding analyses, the results were unchanged.)
Dextran - nine trials compared dextran with a crystalloid, n = 834 patients. The pooled RR was 1.24 (95% CI 0.94 to 1.65).

Colloids in hypertonic crystalloid compared to isotonic crystalloid

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

Authors' conclusions

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

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary

Are colloids more effective than crystalloids in reducing mortality in people who are critically ill or injured

Trauma, burns or surgery can cause people to lose large amounts of blood. Fluid replacement, giving fluids intravenously (into a vein) to replace lost blood, is used to try to maintain blood pressure and reduce the risk of dying. Blood products, non-blood products or combinations are used, including colloid or crystalloid solutions. Colloids are increasingly used but they are more expensive than crystalloids. The review of trials found no evidence that colloids reduce the risk of dying compared with crystalloids.