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Abstract
Controversy persists over the best choice of fluid to use for resuscitation. A number
of published articles promote the use of either colloid or crystalloid fluids. Most
of the arguments for use of one fluid or the other are based on cardiopulmonary data
collected during and after fluid resuscitation. Although many studies report the mortality
rate of patients treated with both fluids, none have critically analyzed this most
important aspect of therapy. Meta-analysis is a relatively new statistical method
whereby data from a number of clinical trials can be pooled to produce more reliable
data. In this study meta-analysis was used to pool mortality data from reports of
eight previously published, randomized, clinical trials, in which the efficacy of
crystalloid and colloid fluid resuscitation was compared. The overall treatment effect
when the data from all the clinical trails were pooled showed a 5.7% relative difference
in mortality rate in favor of crystalloid therapy. When the data from only those studies
using trauma patients were pooled, the overall treatment effect showed a 12.3% difference
in mortality rate in favor of crystalloid therapy. However, when data from studies
that used nontrauma patients were pooled, there was a 7.8% difference in mortality
rate in favor of colloid treatment. In patients with trauma who are septic and in
whom the capillary leak syndrome leads to adult respiratory distress syndrome, it
may be assumed that colloid resuscitation would be no better than crystalloid resuscitation.
In this study the meta-analysis of published data showed that this form of treatment
is deleterious. In patients who are nonseptic or having elective surgery, however,
the basement membrane is intact, and meta-analysis of data in this setting showed
that treatment with colloids would be efficacious.
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Article info
Publication history
Accepted:
April 28,
1988
Footnotes
☆The views expressed herein are those of the author and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the U.S. Government.
Identification
Copyright
© 1989 Published by Elsevier Inc.
