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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)

 
Characteristics of included studies [ordered by study ID]

MethodsRandomised 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.


Participants55 patients undergoing elective aorta-coronary bypass surgery.
Exclusion criteria were ejection fraction < 50% and LVEDP > 15 mmHg.


Interventions
  1. 300ml 20% human albumin solution (n = 15).
  2. 500ml 3% hydroxyethyl starch (n = 13).
  3. 500ml 3.5% gelatin (n = 14).
  4. No colloid (n = 13).


OutcomesHaemodynamic variables were measured.
Deaths not reported.


NotesFollow up until discharge from intensive care.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsRandomised controlled trial.
Allocation concealment by sealed opaque envelopes (information from author).
Blinding and loss to follow up not mentioned.


Participants75 males undergoing elective aortocoronary bypass grafting, who had a pulmonary capillary wedge pressure of less than 5 mmHg after induction of anaesthesia.


Interventions
  1. 5% albumin (n = 15).
  2. 6% HES, mean molecular weight 450,000 (n = 15).
  3. 6% HES, mean molecular weight 200,000 (n = 15).
  4. 3.5% gelatin (n = 15).
  5. No colloid (n = 15).


Fluid used through operation and on intensive care post-op.


OutcomesDeaths not reported, author confirmed there were no deaths.


NotesFollow up to 1 day.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsRandomised controlled trial, using a closed-envelope system.


Participants100 patients undergoing major abdominal surgery.


Interventions
  1. Ringer's lactate (n = 25).
  2. 6% HES, mean molecular weight 200kDa, degree of substitution 0.5 (n = 25).
  3. 6% HES, mean molecular weight 130kDa, degree of substitution 0.4 (n = 25).
  4. 4% modified fluid gelatin, molecular weight 35kDA (n = 25).


OutcomesDeaths.
Orthostatic problems.
Haemodynamics and laboratory data.
Fluid input and output.
Costs.


NotesFollow-up period unclear.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsRandomised controlled trial ("randomly divided").
Method of allocation concealment not described.
Blinding not mentioned.
No loss to follow up.


Participants24 people undergoing major operative procedures on the abdominal aorta.


Interventions
  1. Albumin in 5% dextrose (n = 7).
  2. 5% dextrose and Ringer's lactate (n = 8).
  3. 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.


OutcomesDeaths reported.


NotesFollow up to discharge from hospital.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsQuasi-randomised controlled trial (allocation by alternation).
Blinding not mentioned.
No loss to follow up.


ParticipantsAdmitted 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
  1. 2ml/kg/%burn Ringer's lactate over 24 hrs, then 0.5ml plasmanate/kg/%burn over 24 hrs plus 5% dextrose (n = 19).
  2. 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).


OutcomesDeaths reported.
Fluid and electrolytes given, weight, haematocrit.


NotesFollow up to 5 days.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?NoInadequate.


MethodsMulticenter, randomised control study. Blinding not mentioned. Use of a two-by-two factorial, open label study design.


ParticipantsCritically 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.


Interventions1. 10% Pentastarch/HES (200/0.5) (n = 262)

2. Modified Ringer's Lactate (n = 275)


OutcomesDeaths 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

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsRandomised controlled trial (allocation by "random numbers").
Blinding not mentioned.
No loss to follow up.


ParticipantsAdults 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
  1. Initial infusion of 250ml 7.5% saline/6% Dextran 60 given IV (16 patients) or intraosseous (n = 10).
  2. 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.


OutcomesDeath.
Haemodynamic variables.


NotesFollow up to 24 hours.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear.


MethodsQuasi-randomised controlled trial (allocation by alternation).
Allocation concealment not reported.
Blinding not reported.
No loss to follow up.


Participants27 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
  1. 6% Haes-Steril (n = 11).
  2. 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.


OutcomesDuration of control of shock.
Recurrence of shock.
Length of ICU stay.
Death not reported as an outcome but they reported that 4 patients died.


NotesLength of follow up not reported but all outcomes were in-hospital.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearNot used


MethodsRandomised controlled trial (allocation by drawing a card from a deck).
Blinding not mentioned.
No loss to follow up.


ParticipantsAdults undergoing elective abdominal aortic surgery.
No exclusions mentioned.


Interventions
  1. 3% Dextran 70 in Ringer's lactate (n = 10).
  2. IV Ringer's lactate (n = 10).


Fluid used during and for 24 hrs after operation, guided by haemodynamic variables.


OutcomesDeath.
Volume transfused, weight change, haemodynamic variables.


NotesFollow up to discharge from hospital.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?NoInadequate


MethodsRandomised controlled trial; allocation by sealed envelope assignment.


Participants60 male patients (of American Society of Anesthesiologists physical status 1 or 2) scheduled for middle ear surgery.


Interventions
  1. Lactated Ringer's solution (n = 15).
  2. 6% HES: molecular weight 200kD, degree of substitution 0.5 (n = 15).
  3. 6% HES: molecular weight 200kD, degree of substitution 0.60-0.66 (n = 15).
  4. 6% HES: molecular weight 450kD, degree of substitution 0.7 (n = 15).


OutcomesDeaths not stated but 'all' patients discharged 10-14 days after surgery; therefore no deaths.
Central venous pressure.
Urine output.
Blood osmolality.
Urine osmolality.


NotesFollow up two days.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsPatients "randomizedly distributed".
Blinding not mentioned.
Unable to assess loss to follow up.


ParticipantsParticipants were undergoing coronary artery bypass surgery.


Interventions
  1. 6% hydroxyethyl starch.
  2. 3.5% gelatin.
  3. Ringer's lactate.


Allocated fluid was used in the post-operative period only guided by mean arterial pressure.


OutcomesDeaths were not reported.
Haemodynamic variables.


NotesFollow up period unspecified.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsRandomised controlled trial, allocation concealment not described.
No blinding.
No loss to follow up mentioned.


ParticipantsPatients with a clinical diagnosis of sepsis.


Interventions
  1. 5% albumin (n = 9).
  2. 0.9% saline (n = 9).


Volume of infusion guided by PAWP.


OutcomesHaemodynamic variables and volume measurements.
Deaths not reported.


NotesFollow up to immediately after infusion.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsQuasi-randomised trial (allocation by day of the week).
Blinding not mentioned.
No loss to follow up.


ParticipantsAged 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
  1. IV haemaccel (n = 11).
  2. IV Ringer's lactate (n = 14).


Fluid was used until vital signs were stable.


OutcomesDeaths from author.
Clotting variables.


NotesFollow up period unspecified.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?NoInadequate


MethodsRandomised controlled trial.
Allocation concealment not reported.
Blinding methods not reported.
Loss to follow up not reported.


Participants55 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
  1. 4.5% Albumin (n = 13).
  2. Gelofusine (n = 14).
  3. Haemaccel (n = 14).
  4. 0.9% Saline (n = 14).


OutcomesHaemostatic parameters.
Death not reported.


NotesLength of follow up not reported but all outcomes were in-hospital.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsRandomised controlled trial. (Patients "randomly" received crystalloid or colloids.)
Method of allocation concealment not reported.
Blinding not reported.
Loss to follow up not reported.


Participants60 patients undergoing knee replacement surgery.
Exclusion criteria were contraindication for regional anaesthesia, known allergies or haemostatic disorders.


Interventions
  1. HES (n = 20).
  2. Modified gelatin (n = 20).
  3. Ringer's solution (n = 20).


Groups 1 and 2 also received a basis of Ringer's solution infusion.


OutcomesCoagulation parameters.
Death not reported.


NotesLength of follow up not reported but all outcomes were in-hospital measures.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsRandomised 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.


ParticipantsPatients after coronary artery bypass graft surgery.
Exclusions: patients with significant left main coronary artery stenosis, poor left ventricular function or poor pulmonary function.


Interventions
  1. IV 5% albumin (n = 5).
  2. IV 6% hydroxyethyl starch (n = 5).
  3. 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.


OutcomesDeaths were not reported. Author contacted and confirmed that there were no deaths in any group.
Haemodynamic data.


NotesFollow up to 1 day.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?YesAdequate


MethodsRandomised controlled trial - assigned by "random numbers table".
Method of allocation concealment unclear.
Blinding not mentioned.
No loss to follow up.


Participants79 previously healthy young adults admitted with burns.
No exclusion criteria reported.


Interventions
  1. 2.5% albumin in Ringer's lactate (n = 40).
  2. 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.


OutcomesDeaths reported.
Lung water in some.
Infections.


NotesFollow up to discharge from hospital.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsRandomised controlled trial.
Method of allocation concealment unclear.
Blinding not mentioned.
No loss to follow up.


Participants20 people undergoing partial gastrectomy.
The average age was 50 years (range 19-84).
No exclusion criteria reported.


Interventions
  1. Colloid group received human albumin solution (n = 14).
  2. Details of crystalloid were not reported (n = 6).


Allocated fluid was continued for 4 days after operation.


OutcomesDeaths reported.
Volumes of fluid given.
Haemodynamic variables.


NotesFollow up to discharge from hospital.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsRandomised controlled trial.
Allocation concealment not reported.
Blinding not reported.
No loss to follow up reported.


Participants42 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
  1. Ringer's Lactate (n = 20).
  2. 6% HES (n = 20).


OutcomesSplanchnic perfusion.
Death not reported but in results authors mentioned that "all patients were discharged."


NotesFollow up to discharge from hospital.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsQuasi-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.


ParticipantsBurns covering more than 10% of the body surface (for children), and more than 15% of the body surface (for adults).
No exclusions mentioned.


Interventions
  1. 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).
  2. 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).


OutcomesDeath.
Fluid given, haemodynamic variables.


NotesFollow up to discharge from hospital.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?NoInadequate


MethodsRandomised controlled trial (method of allocation unclear).
Blinding not mentioned.
No loss to follow up.


ParticipantsAdults undergoing major abdominal surgery.
Exclusions: cardiorespiratory dysfunction, uraemia, diabetes, taking steroids, anticoagulants or diuretics.


Interventions
  1. IV Dextran 70 in saline (concentration not given) with 2.5% dextrose (n = 15).
  2. 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.


OutcomesDeath not reported.
Fluid given, haemodynamic variables.


NotesFollow up to 7 days.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsRandomised controlled trial, method of allocation concealment unclear.
Blinding not mentioned.
No loss to follow up.


Participants19 people with burns covering more than 20% of body surface.


Interventions
  1. 12.5% albumin in hypertonic saline (240MeQ Na+, 120 MeQ chloride, 120 MeQ lactate), (n = 7).
  2. Hypertonic saline (240MeQ Na+, 120 MeQ chloride, 120 MeQ lactate). (n = 5).
  3. Ringer's lactate (n = 7).


Allocated fluid was used, guided by haemodynamic variables, to the end of resuscitation.


OutcomesDeaths reported.
Haemodynamic variables.


NotesFollow up to end of resuscitation.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsRandomised controlled trial. Description of allocation procedure unclear.
Blinding not mentioned.
No loss to follow up.


Participants32 adult men scheduled for coronary artery bypass surgery.
Exclusions: left ventricular ejection fraction under 40%, abnormal lung function.


Interventions
  1. Colloid group received 6% dextran 70 (n = 14).
  2. Ringer's lactate (n = 18).


Allocated fluid was used to the end of resuscitation.


OutcomesDeaths reported.
Haemodynamic variables.
Lung water.


NotesFollow up 2 weeks.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsRandomised controlled trial, using a closed-envelope system.


Participants42 patients scheduled for elective major abdominal surgery.


Interventions
  1. Lactated Ringer's (n = 21).
  2. 6% HES, molecular weight 139kD, degree of substitution 0.4 (n = 21).


OutcomesDeaths.
Haemodynamics and laboratory data.
Tissue oxygenation.
Volume input and output.


NotesFollow up period unclear.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?YesAdequate


MethodsRandomised 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").


Participants36 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
  1. 6% HES (n = 18).
  2. Ringer's Lactate (n = 18).


Additional crystalloid solutions were supplied to equalize insensible fluid loss or as a solvent for drugs in group 1.


OutcomesPro- and anti-inflammatory cytokines.
All patients survived.


NotesLength of follow up not reported but all outcomes were in-hospital measures.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsRandomised controlled trial.
Method of allocation concealment unclear.
Assessment of chest x-ray blinded.
No loss to follow up.


Participants21 people undergoing coronary artery bypass grafting or valve surgery.


Interventions
  1. 6% hetastarch up to 1.5L then 5% plasma protein fraction (n = 11).
  2. 0.9% saline (n = 10).


Allocated fluid was used for post-operative fluid resuscitation.


OutcomesDeaths were not reported.
Pulmonary and peripheral oedema.
Haemodynamic variables.


NotesFollow up to discharge.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsRandomised controlled trial, allocation by sealed envelopes.
Blinding not mentioned.
No loss to follow up.


ParticipantsParticipants with serious trauma.


Interventions
  1. 25% albumin in Ringer's lactate (n = 77).
  2. Ringer's lactate (n = 94).


Allocated fluid was used throughout the pre- and intra-operative period.


OutcomesDeaths reported.


NotesFollow 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

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsRandomised controlled trial.
Randomisation was based on the last digit of each patient's case number.


Participants52 seriously injured patients.


Interventions
  1. 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).
  2. Standard resuscitation regimen as above (n = 25).


OutcomesDeaths reported in some patients.


NotesIn 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

ItemAuthors' judgementDescription

Allocation concealment?NoInadequate


MethodsRandomised controlled trial.
Open label.
Random allocation was assigned by the use of sealed cards.
No loss to follow up.


Participants159 children with severe malaria and metabolic acidosis.
Exclusion criteria included pulmonary oedema, oedematous malnutrition or papilledema.


InterventionsSevere acidosis

  1. 4.5% Albumin (n = 23).
  2. 0.9% Saline (n = 26).


Moderate acidosis

  1. 4.5% Albumin (n = 33).
  2. 0.9% Saline (n = 35).
  3. Control (n = 33).


OutcomesReduction in base deficit.
Neurological sequelae.
Death reported.


NotesLength of follow up not reported but all outcomes were in-hospital measures.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsQuasi-randomised, allocation by alternation.
Double-blind.
2 patients excluded from the analysis as code of fluid lost.


ParticipantsParticipants 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
  1. 250 mL Dextran-70 in 7.5% NaCl (n = 211).
  2. 250 mL Ringer's lactate, saline or plasmalyte (n = 211).


Allocated fluid was for initial pre-hospital resuscitation only.


OutcomesDeaths reported.


NotesFollow up to hospital discharge or transfer.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?NoInadequate


MethodsPatients 'randomized'.
Blinding of care givers by use of pharmacy prepared solutions.
No loss to follow up.


ParticipantsPatients undergoing elective coronary artery surgery.
Exclusions: age over 75, ejection fraction under 35%, creatinine over 135umol/L, ACE inhibitors.


Interventions
  1. 5mL/kg polygeline (n = 10).
  2. 5mL/kg 7.2% saline (n = 10).


Allocated fluid given post-op over one hour. All patients subsequently receive polygeline and red blood cells.


OutcomesHaemodynamic variables.
Death.


NotesFollow up to discharge from intensive care.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsRandomised controlled trial. Method of allocation concealment not described.
Blinding not mentioned.
No loss to follow up.


ParticipantsPatients following elective cardiopulmonary bypass.


Interventions
  1. 5% albumin and cell-saved blood (n = 14).
  2. Plasmalyte and cell-saved blood (n = 14).


Allocated fluid used as part of fluid volume replacement.


OutcomesDeaths not reported.
Study was designed to look at the effect of protein infusion on the accuracy of a haematocrit measuring device.


NotesLength of follow up unspecified.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsRandomised controlled trial.
Blinding not mentioned.
No loss to follow up.


ParticipantsParticipants 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
  1. 5% salt-poor albumin (n = 20).
  2. 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.


OutcomesDeaths reported.
Haemodynamic variables.


NotesFollow up to discharge.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsQuasi-randomised controlled trial, allocation by admission date.
Blinding not mentioned.
No loss to follow up.


ParticipantsParticipants were trauma admissions to an emergency department with a systolic blood pressure of less than 70mmHg. Age range was 20-58 years.


Interventions
  1. Dextran-70 in Ringer's lactate (n = 12).
  2. 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.


OutcomesDeaths reported.
Development of respiratory distress syndrome.


NotesFollow up to definitive reconstructive surgery.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?NoInadequate


MethodsRandomised 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.


Participants90 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
  1. Hetastarch-Normal Saline (n = 30).
  2. Hetastarch-Balanced Salt (n = 30).
  3. Ringer's Lactate (n = 30).


OutcomesPostoperative nausea and vomiting.
Death not reported.


NotesFollow up to discharge.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsRandomised controlled trial, contact with author showed it was an open label study.
Blinding not mentioned.
No loss to follow up.


ParticipantsParticipants were adult admissions to a trauma unit, with measurable systolic blood pressure less than 90 mmHg.


Interventions
  1. Pentastarch in 0.9% NaCl (n = 21).
  2. 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.


OutcomesDeaths were not reported.
Haemodynamic variables.


NotesFollow up to discharge.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?NoInadequate


MethodsRandomised controlled trial, opaque envelopes containing only treatment pack number.


Participants230 children with dengue shock syndrome.


Interventions
  1. Dextran 70 (n = 55).
  2. 3% gelatin (n = 56).
  3. Lactated Ringer's (n = 55).
  4. 'Normal' saline (n = 56).


OutcomesInitial 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


NotesFollow up period unclear.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?YesAdequate


MethodsRandomised controlled trial.
Method of allocation concealment not described.
Blinding not mentioned.
No loss to follow up.


Participants26 patients admitted for reconstructive surgery of the abdominal aorta.


Interventions
  1. 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).
  2. Whole blood and crystalloid, type not specified (n = 13).


OutcomesDeaths not reported.
Author when contacted confirmed that there were no deaths in either group.


NotesLength of follow up 4 days.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsRandomised controlled trial, allocation concealment unclear.
Blinding not mentioned.
Loss to follow up 18/54 in colloid group, 13/53 in saline group.


ParticipantsParticipants required fluid resuscitation as a result of vascular leak syndrome associated with Interleukin-2 therapy for metastatic cancer.


Interventions
  1. 250 mL boluses of 5% albumin in saline (n = 36 reported).
  2. 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.


OutcomesDeaths.
Toxic effects of chemotherapy.
Haemodynamic variables.


Notes


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsRandomised controlled trial.
Blinding not mentioned.
No loss to follow up.


ParticipantsParticipants were undergoing modified Whipple's operation.


Interventions
  1. 10% hydroxyethyl starch in 0.9% saline plus plasma protein fraction if requirements > 20mL/kg (n = 6).
  2. 20% human albumin solution (n = 6).
  3. Ringer's lactate.


Allocated fluid was administered intra-operatively only.


OutcomesDeaths.
Intestinal oedema formation.


NotesFollow up period was unspecified.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsRandomised controlled trial, allocation concealment unclear.
Blinding not mentioned.
No loss to follow up.


ParticipantsParticipants 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
  1. 6% hydroxyethyl starch (n = 9).
  2. 5% albumin (n = 9).
  3. 0.9% saline (n = 8).


Allocated fluid was given as needed until the end of resuscitation.


OutcomesDeaths reported.
Fluid balance.


NotesFollow up to discharge from hospital.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsRandomised controlled trial.


ParticipantsParticipants were admissions to the emergency room, with a systolic blood pressure of 90 mmHg or less and were 16 years of age or older.


InterventionsColloid 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.


OutcomesDeath was the main outcome measure, but the data are unpublished.


NotesFollow up to 30 days. By April 1994, 125 patients had been entered into the study.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsRandomised controlled trial. Randomisation by minimisation algorithm accessed through secure website.


ParticipantsPatients aged 18 years and above admitted to closed multidisciplinary intensive care units in 16 tertiary hospitals in Australia over 19-month period.


Interventions
  1. 4% albumin (Albumex, CSL) (n = 3499).
  2. Normal saline (n = 3501).


OutcomesDeath.
Patients with new single or multiple-organ failure.
Mean number of days: in ICU, in hospital, on mechanical ventilation, on renal replacement therapy.


NotesFollow up to 28 days.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?YesAdequate


MethodsRandomised controlled trial. Allocation by sealed envelope.
Blinding not mentioned.
No loss to follow up.


ParticipantsPatients with severe, multiple trauma and a systolic blood pressure of less than 90mmHg. All patients were adults and both sexes were included.


Interventions
  1. 5% salt-poor albumin in Ringer's lactate (n = 9).
  2. Ringer's lactate (n = 11).


Volume infused guided by physiological parameters.


OutcomesDeath reported.
Haemodynamic variables.


NotesLength of follow up not stated.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsPatients 'assigned randomly'.
Blinding not mentioned.
No loss to follow up.


ParticipantsPeople undergoing aortic reconstruction surgery.
No exclusion criteria mentioned.


Interventions
  1. Plasmanate (n = 9).
  2. Ringer's lactate (n = 9).


Allocated fluid used guided by haemodynamic variables until the first postoperative morning. All patients then received 0.45% saline.


OutcomesLung water.
Haemodynamic variables.
Death.


NotesFollow up to two days post-op.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsPatients "randomly assigned". Blinding not described.
Two patients excluded after randomisation due to arrhythmias on giving the fluid (both in hypertonic saline group).


ParticipantsPatients 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
  1. 250mL 7.2% hypertonic saline, 6%HES (n = 8).
  2. 250mL 7.2% hypertonic saline (n = 10).
  3. 250mL 6% HES (n = 8).


Fluid given over 15mins, 1 hour after admission to post-op intensive care.


OutcomesHaemodynamic 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).


NotesFollow up to discharge from hospital (all within 10 days).


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsRandomised controlled trial, allocation concealment unclear.
Blinding not mentioned.
No loss to follow up.


ParticipantsParticipants were undergoing elective abdominal reconstructive surgery.


Interventions
  1. 25% salt-poor albumin 1g/kg and 5% albumin 1L (n = 7).
  2. Ringer's lactate.


Allocated fluid was given intra-operatively. All patients received crystalloids only for pre-loading before surgery.


OutcomesDeaths were not reported.


Notes


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsRandomised controlled trial, allocation by sealed envelopes.
Blinding not mentioned.
No loss to follow up.


ParticipantsParticipants were adult patients in need of volume replacement during and after coronary artery bypass surgery.


Interventions
  1. Haemaccel (n = 10).
  2. Dextran 70 (n = 10).
  3. Albumin 40 (n = 10).
  4. Ringer's lactate (n = 10).


Allocated fluid was used throughout resuscitation.


OutcomesDeaths reported.
Fluid balance.


NotesFollow up to 48 hours.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsRandomised controlled trial, allocation by sealed envelope. Described as double blind, no loss to follow up mentioned.


ParticipantsPatients 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
  1. 4mL/kg of 75mg/mL hypertonic saline in dextran 70 60mg/mL over 30 mins (n = 10).
  2. 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.


OutcomesFluid balance.
Haemodynamic variables.
Deaths not reported.


NotesFollow up to 48 hours.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsOpen label randomised trial.
Allocation by sealed envelope.
No loss to follow up mentioned.


Participants60 patients with septic shock aged 1 month to 12 years.
Exclusion criteria: age less than one month, multiorgan failure and immunodeficiency states.


Interventions
  1. Normal saline (n = 31).
  2. Polymer from degraded gelatin in saline (gelatin) (n = 29).


OutcomesHaemodynamic data.
Death reported.


NotesLength of follow up not reported but all outcomes were in-hospital measures.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsRandomised controlled trial, allocation concealment unclear.
Double blind study (solutions prepared in identical containers).
No loss to follow up.


ParticipantsParticipants 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
  1. 6% dextran 70 in 7.5% saline (n = 23).
  2. 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.


OutcomesDeaths reported.
Haemodynamic variables.


NotesFollow up to hospital discharge.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsRandomised controlled trial, allocation by randomised sequence of coded containers.
Double blind study.
No loss to follow up.


ParticipantsParticipants 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
  1. 4.2% dextran 70 in 7.5% saline or 6% dextran 70 in 7.5% saline (n = 83).
  2. 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.


OutcomesDeaths reported.
Haemodynamic variables.


NotesFollow 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

ItemAuthors' judgementDescription

Allocation concealment?YesAdequate


MethodsRandomised 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.


ParticipantsParticipants, 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
  1. 6% dextran 70 in 7.5% saline (n = 89).
  2. 7.5% saline (n = 85).
  3. 0.9% saline (n = 84).


Participants received 250mL of the allocated fluid in the pre-hospital setting. Additional isotonic crystalloids were given as needed.


OutcomesDeaths reported.
Haemodynamic variables.
Trauma scores.


NotesFollow up was to discharge from hospital.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?YesAdequate


MethodsRandomised 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.


ParticipantsParticipants 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
  1. 12% dextran 70 in 7.5% saline (n = 49).
  2. 6% dextran 70 in 7.5% saline (n = 50).
  3. 7.5% saline (n = 50).
  4. Ringer's lactate (n = 45).


Participants received 250mL of the allocated fluid in the pre-hospital setting. Additional isotonic crystalloids were given as needed.


OutcomesDeaths reported.
Haemodynamic variables.
Trauma scores and neurological outcome scores.


NotesFollow up to hospital discharge.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?YesAdequate


MethodsRandomised controlled trial.
Allocation concealment by "the sealed envelope method".
Blinding method not reported.
No loss to follow up.


Participants67 patients with presumed hypovolemia after cardiac and major vascular surgery.
Exclusion criteria; age > 79 years and known anaphylactoid reaction to colloids.


Interventions
  1. Saline (n = 16).
  2. Gelatin (n = 16).
  3. HES (n = 16).
  4. Albumin (n = 16).


OutcomesHaemodynamic data.
Death not reported.


NotesLength of follow up not reported but all outcomes were in-hospital measures.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsAllocation "by random number".
Blinding not mentioned.
No loss to follow up.


ParticipantsParticipants were undergoing abdominal aortic surgery.


Interventions
  1. 5% albumin (n = 15).
  2. 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.


OutcomesDeaths reported.


NotesFollow up two and a half weeks.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsPatients "randomly allocated".
Blinding not mentioned.
Two patients excluded as they required reoperation for bleeding.


Participants22 adult patients in need of volume replacement following coronary artery bypass surgery.
Exclusions: abnormal left ventricular function, platelet active medication or heparin.


Interventions
  1. Haemaccel (n = 10).
  2. Ringer's lactate (n = 10).


Allocated fluid was used from the time of admission to intensive care following operation, to the end of resuscitation.


OutcomesDeaths reported.
Pulmonary oedema.


NotesFollow up to discharge.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsRandomised controlled study.
Allocation concealed by specially prepared cardboard containers.
Method of blinding not mentioned.
No loss to follow up.


Participants512 children with Dengue shock syndrome aged 2 to 15 years.


InterventionsChildren with immoderately severe shock were randomised to the three interventions:

  1. Ringer's lactate (n = 128).
  2. 6 percent dextran 70 (n = 126).
  3. 6 percent hydroxyethyl starch 200/0.5 (n = 129).


Children with severe shock were randomized only to either of the two colloids interventions:

  1. 6 percent dextran 70 (n = 67).
  2. 6 percent hydroxyethyl starch 200/0.5 (n = 62).


OutcomesRequirement 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.


NotesLength of follow up not clear.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?YesAdequate


MethodsRandomised controlled trial, allocation concealment by sealed opaque envelopes.
No information on blinding or loss to follow up.


Participants60 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
  1. saline (500ml/24 hr) (n = 16).
  2. albumin 20% (300 ml/24h) (n = 15).
  3. HES 10% (500ml/24h) for 3 days (n = 27).


Aim was to restore colloid osmotic pressure.


OutcomesChanges in fluid balance, serum albumin, COP and clinical signs of oedema were followed daily.
Death rates supplied by the author.


NotesLength of follow up unspecified.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsRandomised controlled trial. No details given of randomisation method.


Participants41 adolescent or adult patients in emergency room suffering from shock.


Interventions
  1. 4% modified fluid gelatin: succinated gelatin 40g/L, sodium chloride 7g/L, sodium hydroxide 1.36g/L (n = 18).
  2. Lactated Ringer's (n = 16).


OutcomesDeath.
Haemodynamic variables.


NotesNot 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

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsRandomised "in a double blind fashion".
Blinding by use of similar bottles.
No loss to follow up.


ParticipantsParticipants 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
  1. 6% dextran 70 in 7.5% saline (n = 35).
  2. 7.5% saline (n = 35).
  3. 0.9% saline (n = 35).


Allocated fluid was for initial bolus of 250mL, followed by isotonic crystalloids as needed.


OutcomesDeaths reported.
Fluid balance.


NotesFollow up to discharge from hospital.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsTrial conducted in a "double blind randomised fashion".
Blinding by use of coded, identical containers.


ParticipantsParticipants 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
  1. 6% dextran 70 in 7.5% saline (n = 101).
  2. 0.9% saline (n = 111).


Allocated fluid was for the first intravenous infusion only.


OutcomesDeaths reported.
Complications.


NotesFollow up period was 30 days.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsRandomised controlled trial, allocation by sealed envelope. Blinding not mentioned, no apparent loss to follow up.


ParticipantsTrauma patients with systolic blood pressure <90mmHg admitted to the emergency room, with no previous treatment.


Interventions
  1. 10% pentastarch (n = 12).
  2. 0.9% saline (n = 11).


Fluid given in 250mL boluses until systolic blood pressure > 100mmHg.


OutcomesDeaths reported.
No complications reported in either group.


NotesFollow up to 24 hours.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsThe 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.


ParticipantsAdult patients undergoing elective major abdominal surgery.


Interventions
  1. 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).
  2. Standard volume replacement regimen as above (n = 15).


OutcomesDeaths reported.
Haemodynamic variables.


NotesLength of follow up unspecified.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear


MethodsThe 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.


Participants18 patients who had undergone elective abdominal aortic surgery.
No exclusions mentioned.


Interventions
  1. 5% human albumin solution (n = 9).
  2. Ringer's lactate solution (n = 9).


Administration guided by pulmonary arterial occlusion pressure.


OutcomesDeaths reported.
Haemodynamic variables.


NotesFollow up to discharge from hospital.


Risk of bias

ItemAuthors' judgementDescription

Allocation concealment?UnclearUnclear

 
Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Artru 1989Intervention to control intracranial pressure not directed at fluid resuscitation.

Bocanegra 1966This 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 1996All groups received some colloid.

Boldt 2007Comparison was not between colloids and crystalloids, rather two different colloid solutions.

Bothner 1998Participants were having minor elective surgery, therefore not considered to be critically ill.

Breheme 1993Intervention directed at haemodilution, not at volume replacement.

Bueno R 2004The participants had elective surgery.

Chin 2006Participants were undergoing elective surgery, therefore not considered to be critically ill.

Golub 1994Albumin given solely as a nutritional supplement.

Goslinga 1992Intervention directed at haemodilution, not volume replacement.

Green 2008Article is a review.

Greenhalgh 1995Intervention directed at the maintenance of serum albumin levels, not for volume replacement.

Hauser 1980Cross-over trial.

Ko 2007Comparison of crystalloids and colloids as preloading solutions.

Krasheninnikov 2007Not a randomised controlled trial.

Lagonidis 1995Intervention was pre-loading for coronary artery bypass surgery.

Lobo 2008Experiment conducted on rabbits.

Marhofer 1999Trial of fluid for preloading before spinal anaesthesia.

Mittermayr 2007Patients were undergoing elective surgery.

Mittermayr 2008Outcome was the change in concentration of tissue-type plasminogen activator.

Niemi 2008Solutions were used for pump priming.

Nilsson 1980Albumin given as a nutritional supplement.

Oliviera 2002The participants had sepsis.

Paton-Gay 2007The outcome was non-relevant to comparing crystalloids and colloids.

Paul 2003The participants had elective surgery.

Rehm 2001Two colloids (albumin and hetastarch) compared.

Steinberg 1989Cross-over trial.

Tiryakioglu 2008Patients were undergoing elective surgery and not considered critically ill. Also, the solutions were used as priming solutions.

Tseng 2008Crystalloid and colloid treatment was not randomised.

Valetova 2007Patients were randomised depending upon their treatment not prior to treatment.

Vercueil 2006Article is a review.

Wilkes 2001One 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 1993This 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.

 
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