Colloids versus crystalloids for fluid resuscitation in critically ill people

Lewis, Sharon R; Pritchard, Michael; Evans, David; Butler, Andrew; Alderson, Phil; Smith, Andrew F; Roberts, Ian

doi:10.1002/14651858.cd000567.pub7

Cited by 162 publications

(169 citation statements)

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“…In a systematic review of 69 RCTs (n = 30,020 patients) that compared the use of crystalloids versus colloids in critically ill patients [54], no outcomes favored the use of colloids. Considering that some colloids are harmful (see below), all colloids are more costly than crystalloids, and availability of colloids is limited in some settings (e.g.…”

Section: Rationalementioning

confidence: 99%

“…A systematic review of 69 RCTs (n = 30,020 patients) compared the use of crystalloids versus colloids in critically ill patients; 24 of these RCTs (n = 11,177 patients) compared the use of crystalloids with the use of starches [54]. When the data were pooled, no statistically significant difference in mortality was observed at the end of follow-up (RR 0.97, 95% CI 0.86-1.09), within 90 days (RR 1.01, 95% CI 0.90-1.14), or within 30 days (RR 0.99, 95% CI 0.90-1.09).…”

Section: Rationalementioning

confidence: 99%

“…In a systematic review of 69 RCTs (n = 30,020 patients) comparing crystalloid versus colloid use in critically ill patients, crystalloids were compared with gelatins in 6 RCTs (n = 1698) [54]. No statistically significant difference in all-cause mortality was observed at the end of the follow-up (RR 0.89, 95% CI 0.74-1.08), within 90 days (RR 0.89, 95% CI 0.73-1.09), or within 30 days (RR 0.92, 95% CI 0.74-1.16), although point estimates favored the use of crystalloids.…”

Section: Rationalementioning

confidence: 99%

“…A systematic review and meta-analysis on crystalloid versus colloid use in critically ill patients identified 19 trials comparing crystalloids with dextrans (n = 4736) [54]. It reported similar mortality rates at the end of follow-up (RR 0.99, 95% CI 0.88-1.11) and within 90 days (RR 0.99, 95% CI 0.87-1.12), but a possibly increased risk of blood transfusion in the dextran arm (RR 0.92, 95% CI 0.77-1.10).…”

Section: Rationalementioning

confidence: 99%

“…A systematic review and meta-analysis identified 20 RCTs (n = 13,047) comparing albumin with crystalloid use [54]. It demonstrated no significant difference in all-cause mortality at the end of the follow-up (RR 0.98, 95% CI 0.92-1.06), within 90 days (RR 0.98, 95% CI 0.92-1.04), or within 30-days (RR 0.99, 95% CI 0.93-1.06).…”

Section: Rationalementioning

confidence: 99%

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Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19)

et al. 2020

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Background: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a rapidly spreading illness, Coronavirus Disease 2019 (COVID-19), affecting thousands of people around the world. Urgent guidance for clinicians caring for the sickest of these patients is needed. Methods:We formed a panel of 36 experts from 12 countries. All panel members completed the World Health Organization conflict of interest disclosure form. The panel proposed 53 questions that are relevant to the management of COVID-19 in the ICU. We searched the literature for direct and indirect evidence on the management of COVID-19 in critically ill patients in the ICU. We identified relevant and recent systematic reviews on most questions relating to supportive care. We assessed the certainty in the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, then generated recommendations based on the balance between benefit and harm, resource and cost implications, equity, and feasibility. Recommendations were either strong or weak, or in the form of best practice recommendations. Results:The Surviving Sepsis Campaign COVID-19 panel issued 54 statements, of which 4 are best practice statements, 9 are strong recommendations, and 35 are weak recommendations. No recommendation was provided for 6 questions. The topics were: (1) infection control, (2) laboratory diagnosis and specimens, (3) hemodynamic support, (4) ventilatory support, and (5) COVID-19 therapy.Recommendation 9. For the acute resuscitation of adults with COVID-19 and shock, we suggest using a conservative over a liberal fluid strategy. Weak recommendation, low-quality evidence.

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Section: Rationalementioning

confidence: 99%

Section: Rationalementioning

confidence: 99%

Section: Rationalementioning

confidence: 99%

Section: Rationalementioning

confidence: 99%

Section: Rationalementioning

confidence: 99%

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