Colloids and crystalloids may have similar effects on mortality when used for fluid replacement in critically ill patients.
Citation: Lewis SR, Pritchard MW, Evans DJW, et al. Colloids versus crystalloids for fluid resuscitation in critically ill people. Cochrane Database of Systematic Reviews 2018; (8): CD000567.
What is this? Some patients with COVID-19 will become critically ill and may need additional fluids to prevent kidney failure. Fluid replacement options include colloids or crystalloids. Colloids are cheap and easy to use but may increase oedema. Crystalloids cost more, provide swifter volume expansion, but may cause allergic reactions, blood clotting disorders and kidney failure.
In this Cochrane systematic review, the authors searched for randomized and quasi-randomized trials, which compared colloid (starches, dextrans, albumin or Fresh Frozen Plasma (FFP)) with crystalloid (isotonic or hypertonic) solutions in patients who were critically ill because of trauma, burns or sepsis and required fluid volume replacement. They did not restrict by date, type or language of publication and did their searches in February 2018. They identified 65 randomised trials and 4 quasi- randomised trials (approximately 30,000 participants). The trials evaluated starch solutions, dextrans, gelatins and albumin or FFP.
What works: Nothing reported.
What doesn’t work: Different forms of colloids (starches, dextrans, albumin or FFP), or gelatins, probably make little or no difference to mortality when compared to crystalloids in critically ill patients. However, starches probably slightly increase the need for blood transfusion and renal replacement therapy.
What’s uncertain: It is uncertain if using dextrans, albumin or FFP or crystalloids affects the need for blood transfusion. It is also uncertain if adverse events are more common with colloids or with crystalloids.
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