Fluid resuscitation with colloid or crystalloid solutions in critically ill patients: a systematic review of randomised trials

摘要

>Objective: To determine the effect on mortality of resuscitation with colloid solutions compared with resuscitation with crystalloids. >Design: Systematic review of randomised controlled trials of resuscitation with colloids compared with crystalloids for volume replacement of critically ill patients; analysis stratified according to patient type and quality of allocation concealment. >Subjects: 37 randomised controlled trials were eligible, of which 26 unconfounded trials compared colloids with crystalloids (n=1622). (The 10 trials that compared colloid in hypertonic crystalloid with isotonic crystalloid (n=1422) and one trial that compared colloid in isotonic crystalloid with hypertonic crystalloid (n=38) are described in the longer version on our website www.bmj.com). >Main outcome measures: Mortality from all causes at end of follow up for each trial. >Results: Resuscitation with colloids was associated with an increased absolute risk of mortality of 4% (95% confidence interval 0% to 8%), or four extra deaths for every 100 patients resuscitated. The summary effect measure shifted towards increased mortality with colloids when only trials with adequate concealment of allocation were included. There was no evidence for differences in effect among patients with different types of injury that required fluid resuscitation. >Conclusions: This systematic review does not support the continued use of colloids for volume replacement in critically ill patients. Key messages class="unordered" style="list-style-type:disc">For decades there has been controversy over the relative benefits of colloid and crystalloid solutions for fluid resuscitation of hypovolaemic patients Although more expensive than crystalloids, use of colloids far exceeds current recommendations In this systematic review of randomised controlled trials we found that, compared with crystalloids, use of colloids was associated with an increase in absolute risk of mortality of 4% There was no evidence for differences of effect among different types of injury necessitating fluid resuscitation