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

BMJ 1998;316:961-964 ( 28 March )

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

Gill Schierhout, lecturer in epidemiology, Ian Roberts, director of Child Health Monitoring Unit.

Department of Epidemiology and Public Health, Institute of Child Health, University College London Medical School, London WC1N 1EH

Correspondence to: Dr Schierhout

Objective: To determine the effect on mortality of resuscitation with colloid solutions compared with resuscitationwith crystalloids.
Design: Systematic review of randomised controlled trials of resuscitation with colloids compared with crystalloidsfor volume replacement of critically ill patients; analysis stratifiedaccording 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 crystalloidwith isotonic crystalloid (n=1422) and one trial that comparedcolloid 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% confidenceinterval 0% to 8%), or four extra deaths for every 100 patientsresuscitated. The summary effect measure shifted towards increasedmortality with colloids when only trials with adequate concealmentof allocation were included. There was no evidence for differencesin effect among patients with different types of injury that requiredfluid resuscitation.
Conclusions: This systematic review does not support the continued use of colloids for volume replacement in criticallyill patients.

Key messages

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

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