Shock: Isotonic crystalloids versus Colloids or hypertonic crystalloids for fluid resuscitation
DISEASE INTERVENTION COMPARISON RESULTS
Crit Care Med. 2011 Feb;39(2):386-91 Meta-Analysis
IN sepsis, septic shock The Use of
colloid albumin-containing solutions
As Treatment, Acute
Is better Than
other fluid, colloid or crystalloids solutions
To reduce death: 0.82, 95%CI 0.67-1.0. Some doubts about the validity of included studies: see the accompanying editorial
N Engl J Med. 2008 Jan 10;358(2):125-39 Randomized Controlled Trial, Multicenter Study
IN sepsis, septic shock The Use of
intensive insulin therapy OR colloid (pentastarch, HES) for fluid resuscitation
As Treatment, Acute
Is worse Than
conventional insulin therapy OR cristalloids (Ringer lactate) for fluid resuscitation
To reduce mortality at 4 weeks. Intensive insulin increased hypoglycemias and HES increased ranal failure.
Crit Care Med. 1999 Jan;27(1):200-10 Meta-Analysis
IN shock The Use of
isotonic crystalloids
As Treatment, Acute
Is equal Than
colloid for fluid resuscitation
To modify mortality, pulmonary edema incidence or length of stay in intensive care unit
Cochrane Database Syst Rev. 2007 Oct 17;(4):CD000567 Systematic Review, Cochrane Review
IN shock, critically ill patients The Use of
crystalloids solutions
As Treatment, Acute
Is equal Than
colloid solutions (albumin, HAS, dextran)
To improve survival (RR 0.88 to 1.24)
Ann Surg. 2011 Mar;253(3):431-41 Randomized Controlled Trial, Multicenter Study
IN shock, trauma, blunt, penetrating The Use of
isotonic normal saline
As Treatment, Acute
Is better Than
hypertonic saline 7.5% solution, alone or with colloids (dextran)
To reduce mortality at 28 days in the subgroup of patients not receiving blood transfusion (5% normal saline VS 10% hypertonic+dextran VS 12% hypertonic saline). Overall survival at 28 days were eqaul in all treatment groups: about 74%