Colloid solutions for fluid resuscitation

  • Review
  • Intervention

Authors

  • Frances Bunn,

    Corresponding author
    1. University of Hertfordshire, Centre for Research in Primary and Community Care, Hatfield, Hertfordshire, UK
    • Frances Bunn, Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK. f.bunn@herts.ac.uk.

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  • Daksha Trivedi

    1. University of Hertfordshire, Centre for Research in Primary and Community Care, Hatfield, Hertfordshire, UK
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Abstract

Background

Colloids are widely used in the replacement of fluid volume. However doubts remain as to which colloid is best. Different colloids vary in their molecular weight and therefore in the length of time they remain in the circulatory system. Because of this and their other characteristics, they may differ in their safety and efficacy.

Objectives

To compare the effects of different colloid solutions in patients thought to need volume replacement.

Search methods

We searched the Cochrane Injuries Specialised Register (searched 1 Dec 2011), Cochrane Central Register of Controlled Trials 2011, issue 4 (The Cochrane Library); MEDLINE (Ovid) (1948 to November Week 3 2011); EMBASE (Ovid) (1974 to 2011 Week 47); ISI Web of Science: Science Citation Index Expanded (1970 to 1 Dec 2011); ISI Web of Science: Conference Proceedings Citation Index-Science (1990 to 1 Dec 2011); CINAHL (EBSCO) (1982 to 1 Dec 2011); National Research Register (2007, Issue 1) and PubMed (searched 1 Dec 2011). Bibliographies of trials retrieved were searched, and for the initial version of the review drug companies manufacturing colloids were contacted for information (1999).

Selection criteria

Randomised controlled trials comparing colloid solutions in critically ill and surgical patients thought to need volume replacement.

Data collection and analysis

Two authors independently extracted the data and assessed the quality of the trials. The outcomes sought were death, amount of whole blood transfused, and incidence of adverse reactions.

Main results

Ninety trials, with a total of 5678 participants, met the inclusion criteria. Quality of allocation concealment was judged to be adequate in 35 trials and poor or uncertain in the rest.

Deaths were obtained in 61 trials. For albumin or PPF versus hydroxyethyl starch (HES) 32 trials (n = 1769) reported mortality. The pooled relative risk (RR) was 1.07 (95% CI 0.87 to 1.32). When the trials by Boldt were removed from the analysis the pooled RR was 0.90 (95% CI 0.68 to 1.20). For albumin or PPF versus gelatin, nine trials (n = 824) reported mortality. The RR was 0.89 (95% CI 0.65 to 1.21). Removing the study by Boldt from the analysis did not change the RR or confidence intervals. For albumin or PPF versus Dextran four trials (n = 360) reported mortality. The RR was 3.75 (95% CI 0.42 to 33.09). For gelatin versus HES 25 trials (n = 1756) reported mortality and the RR was 1.03 (95% CI 0.84 to 1.26). When the trials by Boldt were removed from the analysis the pooled RR was 1.04 (95% CI 0.85 to 1.27). RR was not estimable in the gelatin versus dextran and HES versus dextran groups.

Forty five trials recorded the amount of blood transfused, however quantitative analysis was not possible due to skewness and variable reporting. Twenty-four trials recorded adverse reactions, with two studies reporting possible adverse reactions to Gel and one to HES.

Authors' conclusions

From this review, there is no evidence that one colloid solution is more effective or safe than any other, although the confidence intervals are wide and do not exclude clinically significant differences between colloids. Larger trials of fluid therapy are needed if clinically significant differences in mortality are to be detected or excluded.

Plain language summary

Are particular types of colloid solution safer for replacing blood fluids than others

When a person is bleeding heavily, the loss of fluid volume in their veins can lead to shock, so they need fluid resuscitation. Colloids and crystalloids are two types of solutions used to replace lost blood fluid (plasma). They include blood and synthetic products. Both colloids and crystalloids appear to be similarly effective at resuscitation. There are different types of colloids and these may have different effects. However, the review of trials found there is not enough evidence to be sure that any particular colloid is safer than any other.

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