Colloids versus crystalloids for fluid resuscitation in critically ill patients

Roberts, Ian; Alderson, Phil; Bunn, Frances; Chinnock, Paul; Ker, Katharine; Schierhout, Gill

doi:10.1002/14651858.cd000567.pub2

Cited by 105 publications

(49 citation statements)

References 75 publications

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“…For decades there has been a debate regarding whether one should use crystalloids or colloids [10][11][12][13], but there is also a debate regarding the efficacy of different colloids [14][15][16]. In contrast to colloids, crystalloids have small effects on coagulation, there is no risk of inducing allergic reactions, and they are inexpensive.…”

Section: Introductionmentioning

confidence: 99%

Plasma volume expansion of 5% albumin, 4% gelatin, 6% HES 130/0.4, and normal saline under increased microvascular permeability in the rat

2006

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Objective: To compare the colloids 5% albumin, 4% gelatine, and 6% HES 130/0.4 with one another, and with saline, regarding their plasma expanding effects at increased permeability, and to compare the results with those from a previous study at normal permeability.Design: Prospective controlled randomised laboratory study.Setting: University research laboratory.Subjects: 48 adult male Sprague-Dawly rats.Interventions: Permeability was increased by an injection of 0.5 ml dextran 70 using the fact that dextran causes anaphylactic reaction in the rat. Plasma volume was determined ( 125 I albumin tracer technique) after anaesthesia, 1 h after the dextran injection (before infusion for 10-15 min of 20 ml/kg bw of each of the colloids or 80 ml/kg of saline), and 3 h later. Blood pressure, haematocrit, blood gases and electrolytes were measured. CVP was measured in 4 rats. Measurements and results:Plasma volume was 41.1±1.9 ml/kg at baseline (n=9), and 29.1±4.1 ml/kg (n=35) 1 h after the dextran injection (p<0.05). Three hours after infusion of the plasma expander, plasma volume had increased by 17.1±3.4 ml/kg in the albumin group, by 7.9±3.6 ml/kg in the gelatine group, by 7.4±4.4 ml/kg in the HES group, and by 12.2±3.1 ml/kg in the saline group. It was unchanged in a control group given no solution (n=7 for all groups) (Means ± SD). Conclusion:Albumin was a more effective plasma volume expander than gelatine or HES or saline (p<0.05), which were equally effective. All solutions showed a smaller plasma expanding effect than observed in a previous study with normal permeability.3

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Section: Introductionmentioning

confidence: 99%

Plasma volume expansion of 5% albumin, 4% gelatin, 6% HES 130/0.4, and normal saline under increased microvascular permeability in the rat

2006

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“…As atualizações mais recentes de duas revisões sistemáticas de ensaios clínicos, realizadas pelo Cochrane Injuries Group Albumin Reviewers, não encontraram evidências de que os colóides sejam mais efetivos ou seguros do que os cristalóides na ressuscitação e na expansão de volume em pacientes críticos 9,10 . Outra revisão Cochrane 11 , atualizada em 2004, não encontrou evidências de benefícios do uso da albumina humana na redução da mortalidade de pacientes críticos com hipovolemia, queimaduras e hipoalbuminemia, quando comparado com o uso de outros expansores plasmáticos.…”

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Avaliação do uso de albumina humana em hospital do Rio de Janeiro, Brasil

Matos

Rozenfeld

2005

Cad. Saúde Pública

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A albumina humana é freqüentemente usada sem que haja correspondência entre suas propriedades farmacológicas e as doenças. Este é um estudo das prescrições de albumina humana em um hospital da rede pública no Rio de Janeiro, Brasil, com ênfase no grau de adesão das mesmas a protocolos de tratamento. As informações foram extraídas dos registros do Serviço de Farmácia e dos prontuários médicos de 99 pacientes adultos, que receberam, entre março e agosto de 2001, 1.475 unidades de albumina humana, solicitadas em 498 prescrições. A análise de confiabilidade das informações sobre indicação terapêutica resultou num kappa de 0,79 (IC95%: 0,72-0,85). As indicações terapêuticas foram avaliadas como apropriadas, inapropriadas ou controversas, com base em quatro protocolos de países diferentes. Do total de prescrições, 33,1% foram consideradas apropriadas, 61,8% inapropriadas, 4,6% controversas e 0,4% indeteminadas. Identificaram-se dois casos suspeitos de reações adversas. A proporção de prescrições inapropriadas é preocupante, dado o elevado custo do produto e o seu potencial para causar reações adversas. A implantação das diretrizes nacionais expressas no protocolo da ANVISA é estratégica para a promoção do uso racional da albumina humana em hospitais.

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“…Furthermore, the superiority of colloid as compared to crystalloid solutions for resuscitation in specific groups of critically ill patients also remains a hypothesized but contentious issue. [7][8][9][10][11][12][13][14] A very large, well conducted multicentre randomized controlled trial of 6,997 heterogeneous critically ill patients in need of volume resuscitation compared 4% albumin to normal saline and found no difference in 28-day mortality between the two groups. 15 However, there was a trend towards lower mortality in a severe sepsis subgroup receiving albumin [relative risk ratio of 0.87 and 95% confidence intervals (CI) from 0.74-1.02].…”

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confidence: 99%

Resuscitating patients with early severe sepsis: A Canadian multicentre observational study

McIntyre

Fergusson

Cook

et al. 2007

Can J Anesth/J Can Anesth

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Background: Fluid resuscitation is a key factor in restoring hemodynamic stability and tissue perfusion in patients with severe sepsis. We sought to examine associations of the quantity and type of fluid administered in the first six hours after identification of severe sepsis and hospital mortality, intensive care unit (ICU) mortality, and organ failure. Methods:A retrospective, multicentre cohort study was undertaken at five Canadian tertiary care ICUs. We identified patients with severe sepsis admitted to the ICU between July 1, 2000, and June 30, 2002, using both administrative and clinical databases. Patients were included if they were hypotensive, had an infectious source, and at least two systemic inflammatory response syndrome criteria. We recorded total quantity and type of fluid administered for the first six hours after severe sepsis was identified. The first episode of hypotension defined the starting point for collection of fluid data. Multivariable regression analyses were performed to examine associations between quantity and type of fluid administered and hospital/ICU mortality, and organ failure.Results: Of 2,026 potentially eligible patient charts identified, 496 patients met eligibility criteria. The mean age and Acute Physiology and Chronic Health Evaluation score (APACHE II) were 61.8 ± 16.5 yr and 29.0 ± 8.0, respectively. No associations between quantity or type of fluid administered and hospital mortality or ICU mortality were identified, and there were no statistically significant associations between quantity or type of fluid administered and organ failure. However, more fluid resuscitation was associated with an increased risk of cardiovascular failure [odds ratio (OR) and 95% confidence interval Conclusion:An association between hospital mortality and quantity or type of fluid administered in the first six hours after the diagnosis of severe sepsis was not identifiable. These findings should be considered as hypothesis-generating and warrant confirmation or refutation by randomized controlled trials.

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Colloids versus crystalloids for fluid resuscitation in critically ill patients

Abstract: Analysis 02.01. Comparison 02 colloid and hypertonic crystalloid vs isotonic crystalloid, Outcome 01 deaths. .. Analysis 03.01. Comparison 03 colloid vs hypertonic crystalloid, Outcome 01 deaths. .. .. .. .. . .

Cited by 105 publications

References 75 publications

Plasma volume expansion of 5% albumin, 4% gelatin, 6% HES 130/0.4, and normal saline under increased microvascular permeability in the rat

Plasma volume expansion of 5% albumin, 4% gelatin, 6% HES 130/0.4, and normal saline under increased microvascular permeability in the rat

Avaliação do uso de albumina humana em hospital do Rio de Janeiro, Brasil

Resuscitating patients with early severe sepsis: A Canadian multicentre observational study

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