The quality of evidence is downgraded by study limitations (unclear allocation concealment in 54 of 78 studies).
Colloids are not recommended for fluid resuscitation in critically ill patients.
The recommendation attaches a relatively high value to possible increase in mortality and high cost of colloids compared to crystalloids.
A Cochrane review [Abstract] 1 included 69 studies with 30 020 participants comparing colloids to crystalloids in patients requiring volume replacement. There was no clear evidence that colloids (starches, dextrans, gelatins, and albumin) reduce the risk of death, compared to crystalloids, in patients with trauma, burns or following surgery (table T1, T2, T3). Hydroxyethyl starch slightly increased the need for blood transfusion and renal replacement therapy (table T1).
| Outcome | Relative effect(95% CI) | Risk with crystalloids | Risk with starches (95% CI) | Number of participants(studies)Certainty of the evidence |
|---|---|---|---|---|
| All-cause mortality (at end of follow-up) | RR 0.97(0.86 to 1.09) | 233 per 1000 | 226 per 1000(201 to 254) | 11 177(24)Moderate |
| All-cause mortality (at 90 days) | RR 1.01(0.90 to 1.14) | 238 per 1000 | 241 per 1000(214 to 272) | 10 415(15) Moderate |
| Transfusion of blood products | RR 1.19(1.02 to 1.39) | 299 per 1000 | 356 per 1000(305 to 416) | 1917(8) Moderate |
| Renal replacement therapy | RR 1.30(1.14 to 1.48) | 82 per 1000 | 106 per 1000(93 to 121) | 8527(9) Moderate |
| Outcome | Relative effect(95% CI) | Risk with crystalloids | Risk with albumin (95% CI) | Number of participants(studies)Certainty of the evidence |
|---|---|---|---|---|
| All-cause mortality (at end of follow-up) | RR 0.98(0.92 to 1.06) | 254 per 1000 | 249 per 1000(234 to 270) | 13 047(20)Moderate |
| All-cause mortality (at 90 days) | RR 0.98(0.92 to 1.04) | 259 per 1000 | 254 per 1000(239 to 270) | 12 492(10) Moderate |
| Transfusion of blood products | RR 1.31(0.95 to 1.80)290(3 | 281 per 1000 | 368 per 1000(267 to 506) | 290(3) Very low |
| Renal replacement therapy | RR 1.11 (0.96 to 1.27) | 201 per 1000 | 223 per 1000(193 to 255) | 3028(2) Low |
| Outcome | Relative effect(95% CI) | Risk with crystalloids | Risk with intervention(95% CI) | Number of participants(studies)Certainty of the evidence |
|---|---|---|---|---|
| Dextran: All-cause mortality (at end of follow-up) | RR 0.99(0.88 to 1.11) | 237 per 1000 | 235 per 1000(209 to 263) | 4736(19) Moderate |
| Dextran: All-cause mortality (at 90 days) | RR 0.99(0.87 to 1.12) | 258 per 1000 | 256 per 1000(225 to 289) | 3353(10) Moderate |
| Gelatin: All-cause mortality (at end of follow-up) | RR 0.89(0.74 to 1.08) | 301 per 1000 | 268 per 1000(223 to 325) | 1698(6) Low |
| Gelatin: All-cause mortality (at 90 days) | RR 0.89 (0.73 to 1.09) | 334 per 1000 | 298 per 1000(244 to 364) | 1388(1) Low |
An analysis 2 of a nationwide trauma registry in Germany included 48 484 patients with mean age of 49 years and mean injury severity score of 23 points; 72.3% were male and 95.5% had blunt trauma. Risk-adjusted analyses revealed that patients receiving over 1 000 ml synthetic colloids experienced an increase of renal failure and renal replacement therapy rates (OR 1.42 and 1.32, respectively, both p ≤ 0.006). Any synthetic colloid use was associated with an increased risk of multiple organ failure (p < 0.001), but there was no effect on hospital mortality (p = 0.594).
Date of latest search: 2020-01-04
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