Shirin Shafazand, MD, MS, FCCP, D.ABSM, FRCP(C)
In critically ill patients, is fluid resuscitation with colloids (alone or with crystalloids) better than resuscitation with crystalloids for mortality?
MEDLINE, Web of Science, and MetaRegister (to December 2006); EMBASE/Excerpta Medica (to wk 50, 2006); CENTRAL (Cochrane Library) and National Research Register (Issue 4, 2006); PubMed (Oct to Dec 2006); Cochrane Injuries Group's specialized register; references of relevant trials and reviews; and trial authors.
Randomized controlled trials (RCTs) that compared colloids (dextran 70, hydroxyethyl starches, modified gelatins, albumin, or plasma protein fraction [PPF]) with crystalloids (isotonic or hypertonic) for volume replacement in critically ill patients, including those with trauma or burns, having surgery, or with such conditions as complications of sepsis. Crossover trials and trials in neonates or preoperative, elective surgical patients were excluded. 58 RCTs and 6 quasi-RCTs met the selection criteria. 8 RCTs reported adequate allocation concealment, 38 had no loss to follow-up, and blinding was not well reported.
Meta-analyses showed that fluid resuscitation with colloids did not differ from resuscitation with crystalloids for mortality; results were consistent for different colloids—albumin or PPF, hydroxyethyl starch, modified gelatin, and dextran (Table). Resuscitation with dextran in hypertonic crystalloid did not differ from resuscitation with isotonic crystalloid (Table).
Fluid resuscitation with colloids does not reduce mortality more than resuscitation with crystalloids in critically ill patients.
Fluid resuscitation with colloids vs crystalloids for mortality in critically ill patients*
*NS = not significant; PPF = plasma protein fraction; other abbreviations defined in Glossary. RRR, RRI, NNT, NNH, and CI calculated from data in article using a fixed-effects model.
†Information provided by author.
Shafazand S. Review: Fluid resuscitation with colloids does not reduce mortality more than crystalloids in critically ill patients. Ann Intern Med. 2008;148:JC3–9. doi: 10.7326/0003-4819-148-10-200805200-02009
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Published: Ann Intern Med. 2008;148(10):JC3-9.
Emergency Medicine, Endocrine and Metabolism, Fluid and Electrolyte Disorders, Nephrology, Pulmonary/Critical Care.
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