Review of article: Effects of fluid resuscitation with colloids versus crystalloids on mortality in critically ill patients presenting with hypovolemic shock the CRISTAL randomized trial by Djillali Annane, Shidasp Siami, Samir Jaber, et al (JAMA 2013;310:1809-17)

摘要

Fluid resuscitation in hypovolemic shock has long been a source of controversy and debate. Research regarding the use of colloids versus crystalloids for volume replacement during resuscitation has varying recommendations regarding selection, efficacy, costs, and complications.1"4 Additional studies have assessed hemodynamic stabilization of the patient against the mortality rate. The purpose of the Colloids versus Crystalloids for the Resuscitation of the Critically 111 (CRISTAL) trial was to examine if colloids altered mortality in comparison to crystalloids for fluid resuscitation in critically ill patients in intensive care units (ICUs). CRISTAL was an international, nonblinded, randomized clinical trial conducted in 2 parallel groups. It included 57 participating ICUs in France, Belgium, Canada, Algeria, and Tunisia from February 2003 to August 2012. Colloids (experimental group) were defined as any combination of hypo-oncotic (gelatins, 4% or 5% albumin) and hyperoncotic (dextrans, hydroxyethyl starches, and 20% or 25% albumin) solutions. The only restriction in the experimental group was that hydroxyethyl starch (Hespan) administration could not exceed 30 mL/kg.