Scandinavian clinical practice guideline on choice of fluid in resuscitation of critically ill patients with acute circulatory failure

Abstract

Background The task force on Acute Circulatory Failure of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine produced this guideline with recommendations concerning the use of crystalloid vs. colloid solutions in adult critically ill patients with acute circulatory failure. Methods Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to grade the quality of evidence and to determine the strengths of the recommendations. As efficacy and harm may vary in different subpopulations of patients with acute circulatory failure, we produced recommendations for general intensive care unit (ICU) patients and those with sepsis, trauma and burn injury. Results For general ICU patients and those with sepsis, we recommend using crystalloids for resuscitation rather than hydroxyethyl starch and we suggest using crystalloids rather than gelatin and albumin. For patients with trauma we recommend to use crystalloids for resuscitation rather than colloid solutions. For patients with burn injury we provide no recommendations as there are very limited data from randomised trials on fluid resuscitation in this patient population. Conclusions We recommend using crystalloid solutions rather than colloid solutions for resuscitation in the majority of critically ill patients with acute circulatory failure.

Adverse effects of crystalloid and colloid fluids

“…Reports of acute kidney injury from HES in septic patients have initiated world-wide scepticism against the use of colloid fluids among researchers. Current guidelines in Scandinavia recommend crystalloid fluid if no clear difference in outcome is evident between crystalloids and colloids [27]. The volume-associated adverse effects of crystalloids appear to be overlooked.…”

Scandinavian SSAI clinical practice guideline on choice of inotropic agent for patients with acute circulatory failure

“…This group identified four key interventions needing guidelines, including fluid resuscitation,2 vasopressor therapy,3 inotropic therapy, and cardiovascular diagnostics and monitoring. This is the group's third guideline: choice of inotropic agent for adult patients with acute circulatory failure.…”

“…Initial support of the failing circulation usually includes fluid resuscitation in combination with the administration of a vasopressor 1. In two recently published Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI) clinical practice guidelines, we have proposed recommendations regarding choice of fluid2 and choice of first‐line vasopressor3 in the management of adult patients with acute circulatory failure. In collaboration with the Canadian Critical Care Society, SSAI has also recently issued recommendations for blood pressure targets in adult critically ill patients with hypotension 4…”

Use of infusion solutions in critically ill: Literature review

“…Primena želatina još uvek ne može pouzdano da se preporuči, jer ne postoje randomizovane studije koje su poredile želatine i kristaloide 46 .…”

“…Prema preporukama 46 koje daju skandinavski istraživači, primena kristaloida ima prednost nad koloidima. Na osnovu njihove metaanalize, koloidi daju veću smrtnost kod pacijenata sa traumom.…”