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 included 78 (70 with mortality data) studies comparing colloids to crystalloids in patients requiring volume replacement. There was no evidence that resuscitation with colloids reduces the risk of death, compared to resuscitation with crystalloids, in patients with trauma, burns or following surgery. 24 trials reported data on mortality with albumin or plasma protein fraction, including a total of 9 920 patients. The pooled risk ratio (RR) from these trials was 1.01 (95 % confidence interval (CI) 0.93 to 1.10). When the trial with poor-quality allocation concealment was excluded, pooled RR was 1.00 (95 % CI 0.92 to 1.09). 25 trials compared hydroxyethyl starch with crystalloids and included 9 147 patients. The pooled RR was 1.10 (95 % CI 1.02 to 1.19). 11 trials compared modified gelatin with crystalloid and included 506 patients. The pooled RR was 0.91 (95 % CI 0.49 to 1.72). Nine trials compared dextran with a crystalloid and included 834 patients. The pooled RR was 1.24 (95 % CI 0.94 to 1.65). The pooled RR for death with albumin versus crystalloids was 1.01 (95 % CI 0.93 to 1.10). The pooled relative risk of death with hydroxyethyl starch was 1.10 (95 % CI 1.02 to 1.19) suggesting that a mortality reduction is highly unlikely and that there may be an increase in the risk of death.
Date of latest search: 2013-01-17