Fluid Resuscitation, Which Fluid is the Best for Each Patient? A Systematic Review and Meta Analysis

Abstract

Context: Fluid therapy is the basis of resuscitation; however, there has been a heated debate on the choice of appropriate fluid. This study mainly aimed to determine which fluid is correlated with a decline in mortality rate and can be the most suitable choice for each group of patients. Evidence Acquisition: We conducted a systematic search on Google Scholar, Web of Science, Scopus, BMJ Journals, Thieme, Path Consult, BIDS Index, Embase, Medline, and Cochrane Controlled Trials up to April 2016. The relevant studies were those that provided a comparison between the effects of different fluids on the mortality rate of patients. Two independent authors participated in the evaluating methodological quality, selecting eligible studies, and extracting the relevant data from the studies. Results: We selected 26 out of 2724 potential randomized controlled trials (RCTs) from the databases for both quantitative and qualitative analyses resulting in a total of 22882 patients receiving either colloid or crystalloid fluids. The approximated pooled Relative risk (RR) for the death of patients who had been resuscitated with crystalloid fluid therapy rather than colloid fluid therapy was 1.008. This meta-analysis illustrated that there was a decline in the mortality rate with borderline significance in both traumatic and hypovolemic patients through utilizing colloid fluids. The mortality reduced more by using dextran and albumin than using crystalloid fluids. Conclusions:The results of this meta-analysis show that colloid fluids can increase the successful resuscitation rate compared to crystalloid fluids especially in traumatic and hypovolemic patients.Some of the colloids like albumin and dextran have a positive effect on reducing the mortality rate but others like Hetastarch (HES) increase the mortality rate compared to normal saline (NS).