By Stephanie Leveene, medwireNews Reporter
Resuscitation with colloids does not appear to decrease the risk for death, and may even increase mortality, a comprehensive study of trial data reveals.
Researchers Pablo Perel (London School of Hygiene & Tropical Medicine, UK) and colleagues report that in postsurgical patients or patients with burns or trauma, colloids do not improve outcomes compared with crystalloids and are more expensive. Also, the use of hydroxyethyl starch may increase mortality risk. "Since colloid use is not associated with improved survival and colloids are considerably more expensive than crystalloids, it is hard to see how their continued use in clinical practice can be justified," say the researchers.
In this meta-analysis, Perel et al reviewed data from 67 controlled trials of critically ill patients requiring volume replacement who were randomly assigned to receive colloids or crystalloids (controls). The principal outcome measure was mortality from all causes.
Results are reported in The Cochrane Library. For the trials directly comparing colloids with crystalloids, the pooled risk ratio (RR) for mortality ranged from 0.91 to 1.24, depending on the type of colloid used (albumin, plasma protein faction, hydroxyethyl starch, modified gelatin, or dextran), suggesting that overall there is no mortality benefit with colloid use.
The 25 trials that included hydroxyethyl starch as a comparator enrolled a total of 9147 patients. The number of deaths noted was large and the pooled RR for mortality was 1.10. This suggests that "a mortality reduction is highly unlikely and that there may be an increase in the risk of death," according to Perel et al.
In studies comparing colloids in hypertonic versus isotonic crystalloids, the colloids in hypertonic crystalloid had a slightly more beneficial effect on mortality. However, the researchers comment that "the results are compatible with the play of chance."
The researchers acknowledge differences in the trials in terms of resuscitation regimen, type of agent used, and protocols to determine the quantity of fluid. "Despite these differences, all participants were in need of volume replacement, and we believe that this variation in the intervention would have an impact on the size of the effect, rather than on its direction."
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