A Systematic Review of the Comparative Safety of Colloids

Abstract

Hypothesis: Safety differences exist among colloids widely used for fluid management in acutely ill patients, as judged according to the comparative incidence of adverse events.Data Sources: Colloid safety data for human subjects were sought, without language or time period restrictions, by means of computer searches of bibliographic and clinical trial databases, hand searches of medical journals and Index Medicus, inquiries with investigators and colloid suppliers, and examination of reference lists. Search terms included "colloids", "morbidity", and "mortality".Study Selection: Controlled trials, cohort studies, pharmacovigilance studies, and prior meta-analyses were independently selected by 2 unblinded investigators. Of 189 candidate studies, 113 were included, with safety data encompassing 1.54 ϫ 10 6 patients and 1.09 ϫ 10 8 colloid infusions.Data Extraction: Two unblinded investigators independently extracted data. Study limitations and confounding factors were tabulated.

Polygeline in patients with hypovolemia caused by accidental trauma: a prospective, multicentric, safety study

“…Many studies have reported about the anaphylactic reactions after polygeline infusion. 10,11 Other safety concerns reported with regard to polygeline use are coagulopathy and circulatory disturbances. [9][10][11]16 In one such study reported in Sweden between 1971 and 1977, 9 cases of anaphylactic reactions were observed.…”

“…In contrast to the concerns reported by reviews and meta-analyses regarding the safety of polygeline, no ADRs or any unusual clinically significant changes were reported within 6 hours of polygeline administration in this study. [9][10][11]16 Worsening of symptoms due to any underlying medical history was not reported for any patient.…”

Sepsis in pregnancy and early goal-directed therapy

“…24 The incidence of allergic reactions is greatest with gelatins and dextran, followed by HES, and least with albumin. 25 While the optimal fluid therapy for septic patients is undecided, crystalloid overload is known to be harmful. 26,27 Albumin is a scarce resource, very expensive, has the potential to transmit viral disease and may not be as physiologically beneficial as low molecular weight starch.…”

Infusion solutions of gelatin derivates

“…Nustatyta, jog visi koloidai, išskyrus želatinos tirpalus, gali sukelti hiperonkotinį ūminį inkstų funkcijos nepakankamumą dėl tirpale esančių makromolekulių, kurios negali prasiskverbti per inkstų kanalėlius, todėl prasideda inkstų kanalėlių stazė ir obstrukcija, o sergantiesiems sepsiu hidroksietilkrakmolo dariniai yra ūminio inkstų funkcijos nepakankamumo rizikos veiksnys (3,5,9). Sergančiuosius inkstų funkcijos nepakankamumu gydant krakmolo tirpalais, gali pasireikšti portinė hipertenzija ir ascitas (10,12).…”