Colloids versus crystalloids for fluid resuscitation in critically ill patients

Area of Science:

• Critical Care Medicine
• Clinical Trials
• Fluid Resuscitation

Background:

• Colloid solutions are frequently used for fluid resuscitation in critically ill patients.
• The comparative effectiveness of different colloids versus crystalloids remains a subject of debate.

Purpose of the Study:

• To evaluate the impact of colloid administration versus crystalloid administration on mortality in critically ill patients requiring fluid resuscitation.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs) comparing colloids and crystalloids.
• Searches included major databases like Cochrane, MEDLINE, and EMBASE up to September 2008.
• Data extraction and quality assessment were performed independently by two authors, with stratified analysis by colloid type and allocation concealment quality.

Main Results:

• No significant difference in mortality was observed when comparing albumin/plasma protein fraction to crystalloids (RR 1.01, 95% CI 0.92-1.10).
• Hydroxyethyl starch (RR 1.18, 95% CI 0.96-1.44), modified gelatin (RR 0.91, 95% CI 0.49-1.72), and dextran (RR 1.24, 95% CI 0.94-1.65) also showed no mortality benefit over crystalloids.
• Colloids in hypertonic crystalloid did not demonstrate a mortality benefit compared to isotonic crystalloid (RR 0.88, 95% CI 0.74-1.05).

Conclusions:

• Randomized controlled trials provide no evidence that colloid resuscitation improves survival compared to crystalloids in patients with trauma, burns, or post-surgery.
• Colloids are not associated with improved survival and are more expensive than crystalloids.
• The continued use of colloids in these patient populations, outside of clinical trials, is difficult to justify based on current evidence.