Colloids and crystalloids may have similar effects on mortality when used for fluid replacement in critically ill patients.

Added March 16, 2020

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.

 

Disclaimer: This summary has been written by staff and volunteers of Evidence Aid in order to make the content of the original document accessible to decision makers who are searching for the available evidence on the coronavirus (COVID-19) but may not have the time, initially, to read the original report in full. This summary is not intended as a substitute for the medical advice of physicians, other health workers, professional associations, guideline developers, or national governments and international agencies. If readers of this summary think that the evidence that is presented within it is relevant to their decision-making they should refer to the content and details of the original article, and the advice and guidelines offered by other sources of expertise, before making decisions. Evidence Aid cannot be held responsible for any decisions made about the coronavirus (COVID-19) on the basis of this summary alone.

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