SynthesisThe Cochrane database of systematic reviews2004
Colloids versus crystalloids for fluid resuscitation in critically ill patients.
Synthesis in The Cochrane database of systematic reviews, 2004. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00517127 (A Comparison of Crystalloids vs. Colloids for Intraoperative Goal-directed Fluid Management), which is not on this map. Cited by 39 papers, 6 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
A Comparison of Crystalloids vs. Colloids for Intraoperative Goal-directed Fluid Management
Who cites it
39 citing papers in PubMed, 6 syntheses or guidelines pooled it, 138 citations in OpenAlex.
- A Systematic Review of Neuroprotective Strategies during Hypovolemia and Hemorrhagic Shock.International journal of molecular sciences · 2017Pooled it
- Recommendations for the transfusion management of patients in the peri-operative period. II. The intra-operative period.Blood transfusion = Trasfusione del sangue · 2011Guideline
- Choice of fluids for resuscitation in children with severe infection and shock: systematic review.BMJ (Clinical research ed.) · 2010Pooled it
- Management of bleeding following major trauma: an updated European guideline.Critical care (London, England) · 2010Guideline
- Recommendations for the use of albumin and immunoglobulins.Blood transfusion = Trasfusione del sangue · 2009Guideline
- Management of bleeding following major trauma: a European guideline.Critical care (London, England) · 2007Guideline
- Phase II trial of isotonic fluid resuscitation in Kenyan children with severe malnutrition and hypovolaemia.BMC pediatrics · 2010Trial
- Greater cardiac response of colloid than saline fluid loading in septic and non-septic critically ill patients with clinical hypovolaemia.Intensive care medicine · 2010Trial
- Cardiac response is greater for colloid than saline fluid loading after cardiac or vascular surgery.Intensive care medicine · 2006Trial
- New Trends and Advances in Non-Variceal Gastrointestinal Bleeding-Series II.Journal of clinical medicine · 2021Review
- British Society of Gastroenterology (BSG)-led multisociety consensus care bundle for the early clinical management of acute upper gastrointestinal bleeding.Frontline gastroenterology · 2020Article
- Starch Wars-New Episodes of the Saga. Changes in Regulations on Hydroxyethyl Starch in the European Union.Frontiers in veterinary science · 2018Review
- Postoperative fluid management.World journal of critical care medicine · 2015Review
- Stimulation of Wnt/β-catenin signaling pathway with Wnt agonist reduces organ injury after hemorrhagic shock.The journal of trauma and acute care surgery · 2015Article
- Critical care medicine 2013: a review and prospect.Journal of thoracic disease · 2013Review
- Spanish Consensus Statement on alternatives to allogeneic blood transfusion: the 2013 update of the "Seville Document".Blood transfusion = Trasfusione del sangue · 2013Article
- Impact of fluid therapy on apoptosis and organ injury during haemorrhagic shock in an oxygen-debt-controlled pig model.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2013Article
- Pediatric burn injuries.International journal of critical illness and injury science · 2012Article
- Recommendations for sepsis management in resource-limited settings.Intensive care medicine · 2012Review
- Consensus statement of the ESICM task force on colloid volume therapy in critically ill patients.Intensive care medicine · 2012Article
Corrections and comments
- Updated by
- Update of
Authors and funding
6 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundColloid 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.
objectivesTo assess the effects on mortality of colloids compared to crystalloids for fluid resuscitation in critically ill patients. SEARCH STRATEGY: We searched the Injuries Group specialised register, Cochrane Controlled Trials Register, MEDLINE, EMBASE and BIDS Index to Scientific and Technical Proceedings, and checked reference lists of trials and review articles. SELECTION CRITERIA: All randomised and quasi-randomised trials of colloids compared to crystalloids, in patients requiring volume replacement. Cross-over trials and trials in pregnant women and neonates were excluded. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and rated quality of allocation concealment. Trials with a 'double-intervention', such as those comparing colloid in hypertonic crystalloid to isotonic crystalloid, were analysed separately. The analysis was stratified according to colloid type and quality of allocation concealment. MAIN
resultsColloids compared to crystalloidsAlbumin or plasma protein fraction. Nineteen trials reported data on mortality, including a total of 7576 patients. The pooled relative risk (RR) from these trials was 1.02 (95% confidence interval [95% CI] 0.93 to 1.11). When the trial with poor quality allocation concealment was excluded, pooled RR was 1.01 (95% CI 0.92 to 1.10). Hydroxyethyl starch. Ten trials compared hydroxyethyl starch with crystalloids, including a total of 374 randomised participants. The pooled RR was 1.16 (95% CI 0.68 to 1.96). Modified gelatin. Seven trials compared modified gelatin with crystalloid, including a total of 346 randomised participants. The pooled RR was 0.54 (95% CI 0.16 to 1.85). Dextran. Nine trials compared dextran with a crystalloid, including a total of 834 randomised participants. The pooled relative risk was RR 1.24 (95% CI 0.94 to 1.65). Colloids in hypertonic crystalloid compared to isotonic crystalloidEight 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). REVIEWERS'
conclusionsThere is no evidence from randomised controlled trials 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 randomised controlled trials.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.