This paper is only available as a PDF. To read, Please Download here.
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.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Comparisons of colloids and crystalloids in resuscitation from hemorrhagic shock.Surg Gynecol Obstet. 1982; 154: 577-586
- Volume replacement in hemorrhage, shock, and burns.Adv Shock Res. 1980; 3: 47-56
- Balanced electrolyte solutions: experimental and clinical studies.Crit Care Med. 1979; 7: 98-106
- Physiologic basis for the clinical use of albumin solutions.Surg Gynecol Obstet. 1978; 146: 97-104
- Crystalloid versus colloid for fluid resuscitation of hypovolemic patients.Adv Shock Res. 1983; 9: 203-216
- Fluid resuscitation: colloid versus crystalloid.Conn Med. 1986; 50: 689-691
- Hypertonic sodium chloride solutions for the prehospital management of traumatic hemorrhagic shock: a possible improvement in the standard of care?.Ann Emerg Med. 1986; 15: 1411-1414
- Meta-analysis in clinical trials.Controlled Clin Trials. 1986; 7: 177-188
- Adjuvant chemotherapy for breast cancer: a pooled estimate based on published randomized controlled trials.JAMA. 1986; 256: 1148-1159
- Acute respiratory failure in the adult (first of three parts).N Engl J Med. 1972; 287: 690-698
- Capillary leak syndrome with pulmonary edema.Arch Intern Med. 1972; 130: 66-71
- Pulmonary extravasation of albumin during and after hemorrhagic shock in baboons.J Surg Res. 1975; 18: 91-97
- Crystalloid versus colloid in fluid resuscitation of patients with severe pulmonary insufficiency.Surg Gynecol Obstet. 1984; 158: 207-212
- Colloid osmotic pressure and fluid resuscitation with hetastarch, albumin, and saline solutions.Crit Care Med. 1982; 10: 159-162
- Colloid or crystalloid in the resuscitation of hemorrhagic shock: a controlled clinical trial.Surgery. 1981; 89: 434-438
- Comparison of the relative effectiveness of colloids and crystalloids in emergency resuscitation.Am J Surg. 1981; 142: 73-84
- Comparison of hemodynamic, pulmonary, and renal effects of use of three types of fluids after major surgical procedures on the abdominal aorta.Crit Care Med. 1979; 7: 9-13
- Crystalloid vs. colloid resuscitation: is one better?.Surgery. 1979; 85: 129-139
- Effects of albumin versus non-albumin resuscitation on plasma volume and renal excretory function.J Trauma. 1978; 18: 564-570
- Crystalloid vs colloid in the etiology of pulmonary failure after trauma: a randomized trial in man.Surgery. 1977; 81: 676-683
- Small-volume infusion of 7.5% NaCl in 6% dextran 70 for the treatment of severe hemorrhagic shock in swine.Ann Emerg Med. 1986; 15: 1131-1137
- Advantages of dextran 70 over Ringer acetate solution in shock treatment and in prevention of adult respiratory distress syndrome. A randomized study in man after traumatic-haemorrhagic shock.Resuscitation. 1983; 10: 219-226
- Fluid resuscitation in circulatory shock: a comparison of the cardiorespiratory effects of albumin, hetastarch and saline solutions in patients with hypovolemic and septic shock.Crit Care Med. 1983; 11: 839-850
- Hemodilution and recovery from experimental intestinal shock in rats: a comparison of the efficacy of three colloids and one electrolyte solution.Crit Care Med. 1981; 9: 42-46
- Oxygen transport responses to colloids and crystalloids in critically ill surgical patients.Surg Gynecol Obstet. 1980; 150: 811-816
- Randomized trial of albumin vs. electrolyte solutions during abdominal aortic operations.Surgery. 1975; 78: 291-303
- Parenteral fluid therapy in septic shock: an evaluation of crystalloid and colloid.Am Surg. 1974; 40: 542-547
- Extravascular lung water following hemorrhagic shock in the baboon: comparison between resuscitation with Ringer's lactate and Plasmanate.Ann Surg. 1974; 180: 408-417
- A comparison of asanguineous fluids and whole blood in the treatment of hemorrhagic shock.Surg Gynecol Obstet. 1969; 138: 1247-1257
Accepted: April 28, 1988
☆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.
© 1989 Published by Elsevier Inc.