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Meta-Analysis
. 2018 Aug 3;8(8):CD000567.
doi: 10.1002/14651858.CD000567.pub7.

Colloids versus crystalloids for fluid resuscitation in critically ill people

Sharon R Lewis  1 , Michael W Pritchard, David Jw Evans, Andrew R Butler, Phil Alderson, Andrew F Smith, Ian Roberts
Affiliations
Meta-Analysis

Colloids versus crystalloids for fluid resuscitation in critically ill people

Sharon R Lewis et al. Cochrane Database Syst Rev. .

Abstract

Background: Critically ill people may lose fluid because of serious conditions, infections (e.g. sepsis), trauma, or burns, and need additional fluids urgently to prevent dehydration or kidney failure. Colloid or crystalloid solutions may be used for this purpose. Crystalloids have small molecules, are cheap, easy to use, and provide immediate fluid resuscitation, but may increase oedema. Colloids have larger molecules, cost more, and may provide swifter volume expansion in the intravascular space, but may induce allergic reactions, blood clotting disorders, and kidney failure. This is an update of a Cochrane Review last published in 2013.

Objectives: To assess the effect of using colloids versus crystalloids in critically ill people requiring fluid volume replacement on mortality, need for blood transfusion or renal replacement therapy (RRT), and adverse events (specifically: allergic reactions, itching, rashes).

Search methods: We searched CENTRAL, MEDLINE, Embase and two other databases on 23 February 2018. We also searched clinical trials registers.

Selection criteria: We included randomised controlled trials (RCTs) and quasi-RCTs of critically ill people who required fluid volume replacement in hospital or emergency out-of-hospital settings. Participants had trauma, burns, or medical conditions such as sepsis. We excluded neonates, elective surgery and caesarean section. We compared a colloid (suspended in any crystalloid solution) versus a crystalloid (isotonic or hypertonic).

Data collection and analysis: Independently, two review authors assessed studies for inclusion, extracted data, assessed risk of bias, and synthesised findings. We assessed the certainty of evidence with GRADE.

Main results: We included 69 studies (65 RCTs, 4 quasi-RCTs) with 30,020 participants. Twenty-eight studied starch solutions, 20 dextrans, seven gelatins, and 22 albumin or fresh frozen plasma (FFP); each type of colloid was compared to crystalloids.Participants had a range of conditions typical of critical illness. Ten studies were in out-of-hospital settings. We noted risk of selection bias in some studies, and, as most studies were not prospectively registered, risk of selective outcome reporting. Fourteen studies included participants in the crystalloid group who received or may have received colloids, which might have influenced results.We compared four types of colloid (i.e. starches; dextrans; gelatins; and albumin or FFP) versus crystalloids.Starches versus crystalloidsWe found moderate-certainty evidence that there is probably little or no difference between using starches or crystalloids in mortality at: end of follow-up (risk ratio (RR) 0.97, 95% confidence interval (CI) 0.86 to 1.09; 11,177 participants; 24 studies); within 90 days (RR 1.01, 95% CI 0.90 to 1.14; 10,415 participants; 15 studies); or within 30 days (RR 0.99, 95% CI 0.90 to 1.09; 10,135 participants; 11 studies).We found moderate-certainty evidence that starches probably slightly increase the need for blood transfusion (RR 1.19, 95% CI 1.02 to 1.39; 1917 participants; 8 studies), and RRT (RR 1.30, 95% CI 1.14 to 1.48; 8527 participants; 9 studies). Very low-certainty evidence means we are uncertain whether either fluid affected adverse events: we found little or no difference in allergic reactions (RR 2.59, 95% CI 0.27 to 24.91; 7757 participants; 3 studies), fewer incidences of itching with crystalloids (RR 1.38, 95% CI 1.05 to 1.82; 6946 participants; 2 studies), and fewer incidences of rashes with crystalloids (RR 1.61, 95% CI 0.90 to 2.89; 7007 participants; 2 studies).Dextrans versus crystalloidsWe found moderate-certainty evidence that there is probably little or no difference between using dextrans or crystalloids in mortality at: end of follow-up (RR 0.99, 95% CI 0.88 to 1.11; 4736 participants; 19 studies); or within 90 days or 30 days (RR 0.99, 95% CI 0.87 to 1.12; 3353 participants; 10 studies). We are uncertain whether dextrans or crystalloids reduce the need for blood transfusion, as we found little or no difference in blood transfusions (RR 0.92, 95% CI 0.77 to 1.10; 1272 participants, 3 studies; very low-certainty evidence). We found little or no difference in allergic reactions (RR 6.00, 95% CI 0.25 to 144.93; 739 participants; 4 studies; very low-certainty evidence). No studies measured RRT.Gelatins versus crystalloidsWe found low-certainty evidence that there may be little or no difference between gelatins or crystalloids in mortality: at end of follow-up (RR 0.89, 95% CI 0.74 to 1.08; 1698 participants; 6 studies); within 90 days (RR 0.89, 95% CI 0.73 to 1.09; 1388 participants; 1 study); or within 30 days (RR 0.92, 95% CI 0.74 to 1.16; 1388 participants; 1 study). Evidence for blood transfusion was very low certainty (3 studies), with a low event rate or data not reported by intervention. Data for RRT were not reported separately for gelatins (1 study). We found little or no difference between groups in allergic reactions (very low-certainty evidence).Albumin or FFP versus crystalloidsWe found moderate-certainty evidence that there is probably little or no difference between using albumin or FFP or using crystalloids in mortality at: end of follow-up (RR 0.98, 95% CI 0.92 to 1.06; 13,047 participants; 20 studies); within 90 days (RR 0.98, 95% CI 0.92 to 1.04; 12,492 participants; 10 studies); or within 30 days (RR 0.99, 95% CI 0.93 to 1.06; 12,506 participants; 10 studies). We are uncertain whether either fluid type reduces need for blood transfusion (RR 1.31, 95% CI 0.95 to 1.80; 290 participants; 3 studies; very low-certainty evidence). Using albumin or FFP versus crystalloids may make little or no difference to the need for RRT (RR 1.11, 95% CI 0.96 to 1.27; 3028 participants; 2 studies; very low-certainty evidence), or in allergic reactions (RR 0.75, 95% CI 0.17 to 3.33; 2097 participants, 1 study; very low-certainty evidence).

Authors' conclusions: Using starches, dextrans, albumin or FFP (moderate-certainty evidence), or gelatins (low-certainty evidence), versus crystalloids probably makes little or no difference to mortality. Starches probably slightly increase the need for blood transfusion and RRT (moderate-certainty evidence), and albumin or FFP may make little or no difference to the need for renal replacement therapy (low-certainty evidence). Evidence for blood transfusions for dextrans, and albumin or FFP, is uncertain. Similarly, evidence for adverse events is uncertain. Certainty of evidence may improve with inclusion of three ongoing studies and seven studies awaiting classification, in future updates.

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Conflict of interest statement

Sharon R Lewis: none known Michael W Pritchard: none known Andrew R Butler: none known Phil Alderson: none known Andrew F Smith: none known Ian Roberts: none known

Figures

1
1
Study flow diagram
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies. We did not make judgements for studies that did not report outcomes of interest in the review, which are indicated by blank spaces
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study. We did not make judgements for studies that did not report outcomes of interest in the review, which are indicated by blank spaces
4
4
Funnel plot of comparison 1. Starches vs crystalloid, outcome: 1.1 mortality at end of follow‐up
5
5
Funnel plot of comparison 2. Dextrans vs crystalloid, outcome: 2.1 mortality at end of follow‐up
6
6
Funnel plot of comparison 4. Albumin and FFP vs crystalloid, outcome: 4.1 mortality at end of follow‐up
See this image and copyright information in PMC

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References

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    1. Oliveira RP, Weingartner R, Ribas EO, Moraes RS, Friedman G. Acute haemodynamic effects of a hypertonic saline/dextran solution in stable patients with severe sepsis. Intensive Care Medicine 2002;28(11):1574‐81. [PUBMED: 12415443] - PubMed
Park 2015 {published data only}
    1. Park C, Osawa E, Almeida J, Nakamura R, Duayer I, Fukushima J, et al. Lactated Ringer versus albumin in early sepsis therapy (RASP) study: preliminary data of a randomized controlled trial. Critical Care 2015;1:S125. [PUBMED: 71938758]
Perner 2012 {published data only}
    1. Anthon CT, Muller RB, Haase N, Hjortrup PB, Moller K, Lange T, et al. Effects of hydroxyethyl starch 130/0.42 vs. Ringer's acetate on cytokine levels in severe sepsis. Acta Anaesthesiologica Scandinavica 2017;61(8):904‐13. [PUBMED: 28653377] - PubMed
    1. Haase N, Wetterslev J, Winkel P, Perner A. Bleeding and risk of death with hydroxyethyl starch in severe sepsis: post hoc analyses of a randomized clinical trial. Intensive Care Medicine 2013;39(12):2126‐34. [PUBMED: 24081433] - PubMed
    1. Haase N, Wetterslev J, Winkel P, Perner A. Hydroxyethyl starch 130/0.42 versus Ringer's acetate in severe sepsis: post‐hoc analyses of coagulation, bleeding and transfusion in a randomised trial. Intensive Care Medicine 2013;39(2):S213. [DOI: ] - PubMed
    1. Haase NR. Hydroxyethyl starch in sepsis. Danish Medical Journal 2014;61(1):B4764. [PUBMED: 24393593] - PubMed
    1. Hjortrup PB, Haase N, Wetterslev J, Perner A. Associations of hospital and patient characteristics with fluid resuscitation volumes in patients with severe sepsis: post hoc analyses of data from a multicentre randomised clinical trial. PLOS One 2016;11(5):e0155767. [PUBMED: 27196104] - PMC - PubMed
Philips 2015 {published data only}
    1. Philips CA, Choudhury AK, Sahney A, Maiwall R, Mitra LG, Sarin SK. Comparison and outcomes of 5% albumin vs 0.9% normal saline fluid resuscitation in cirrhotics presenting with sepsis induced hypotension‐a randomized controlled trial‐fluid resuscitation in septic shock in cirrhosis (FRISC Protocol). Hepatology 2015;62:261a. [Issn Print: 0270‐9139]
Pockaj 1994 {published data only}
    1. Pockaj BA, Yang JC, Lotze MT, Lange JR, Spencer WF, Steinberg SM, et al. A prospective randomized trial evaluating colloid versus crystalloid resuscitation in the treatment of the vascular leak syndrome associated with interleukin‐2 therapy. Journal of Immunotherapy with Emphasis on Tumor Immunology 1994;15(1):22‐8. [PUBMED: 8110727] - PubMed
Quinlan 2004 {published data only}
    1. Quinlan GJ, Mumby S, Martin GS, Bernard GR, Gutteridge JM, Evans TW. Albumin influences total plasma antioxidant capacity favorably in patients with acute lung injury. Critical Care Medicine 2004;32(3):755‐9. [PUBMED: 15090958] - PubMed
Rackow 1983 {published data only}
    1. Haupt MT, Rackow EC. Colloid osmotic pressure and fluid resuscitation with hetastarch, albumin, and saline solutions. Critical Care Medicine 1982;10(3):159‐62. [PUBMED: 6174274] - PubMed
    1. Kaufman BS, Rackow EC, Falk JL. Fluid resuscitation in circulatory shock. Colloids versus crystalloids. Current Studies in Hematology & Blood Transfusion 1986;53:186‐98. [PUBMED: 3536330] - PubMed
    1. Rackow EC, Falk JL, Fein IA, Siegel JS, Packman MI, Haupt MT, et al. Fluid resuscitation in circulatory shock: a comparison of the cardiorespiratory effects of albumin, hetastarch, and saline solutions in patients with hypovolemic and septic shock. Critical Care Medicine 1983;11(11):839‐50. [PUBMED: 14245570] - PubMed
Shah 1977 {published data only}
    1. Shah DM, Browner BD, Dutton RE, Newell JC, Powers JC Jr. Cardiac output and pulmonary wedge pressure. Use for evaluation of fluid replacement in trauma patients. Archives of Surgery 1977;112(10):1161‐8. [PUBMED: 907460] - PubMed
Upadhyay 2005 {published data only}
    1. Upadhyay M, Singhi S, Murlidharan J, Kaur N, Majumdar S. Randomized evaluation of fluid resuscitation with crystalloid (saline) and colloid (polymer from degraded gelatin in saline) in pediatric septic shock. Indian Pediatrics 2005;42(3):223‐31. [PUBMED: 40461538] - PubMed
Van der Heijden 2009 {published data only}
    1. Smorenberg A, Groeneveld AB. Diuretic response to colloid and crystalloid fluid loading in critically ill patients. Journal of Nephrology 2015;28(1):89‐95. [PUBMED: 24828327] - PubMed
    1. Spoelstra‐de Man AM, Smorenberg A, Groeneveld AB. Different effects of fluid loading with saline, gelatine, hydroxyethyl starch or albumin solutions on acid‐base status in the critically ill. PLOS One 2017;12(4):e0174507. [PUBMED: 28380062] - PMC - PubMed
    1. Trof RJ, Sukul SP, Twisk JW, Girbes AR, Groeneveld AB. Greater cardiac response of colloid than saline fluid loading in septic and non‐septic critically ill patients with clinical hypovolaemia. Intensive Care Medicine 2010;36(4):697‐701. [PUBMED: 20165941] - PMC - PubMed
    1. Heijden M, Verheij J, Nieuw Amerongen GP, Groeneveld AB. Crystalloid or colloid fluid loading and pulmonary permeability, edema, and injury in septic and nonseptic critically ill patients with hypovolemia. Critical Care Medicine 2009;37(4):1275‐81. [PUBMED: 19242338] - PubMed
Vassar 1990 {published data only}
    1. Holcroft JW, Vassar MJ, Perry CA, Gannaway WL, Kramer GC. Use of a 7.5% NaCl/6% dextran 70 solution in the resuscitation of injured patients in the emergency room. Progress in Clinical and Biological Research 1989;299:331‐8. [PUBMED: 2471213] - PubMed
    1. Vassar MJ, Perry CA, Holcroft JW. Analysis of potential risks associated with 7.5% sodium chloride resuscitation of traumatic shock. Archives of Surgery 1990;125(10):1309‐15. Erratum in Archives of Surgery 1991; 126(1):43. [PUBMED: 1699508] - PubMed
Vassar 1991 {published data only}
    1. Holcroft JW, Vassar MJ, Perry CA, Gannaway WL, Kramer GC. Perspectives on clinical trials for hypertonic saline/dextran solutions for the treatment of traumatic shock. Brazilian Journal of Medical & Biological Research 1989;22(2):291‐3. [PUBMED: 2477096] - PubMed
    1. Holcroft JW, Vassar MJ, Turner JE, Derlet RW, Kramer GC. 3% NaCl and 7.5% NaCl/dextran 70 in the resuscitation of severely injured patients. Annals of Surgery 1987;206(3):279‐88. [PUBMED: 2443087] - PMC - PubMed
    1. Vassar MJ, Perry CA, Gannaway WL, Holcroft JW. 7.5% sodium chloride/dextran for resuscitation of trauma patients undergoing helicopter transport. Archives of Surgery 1991;126(9):1065‐72. [PUBMED: 1718243] - PubMed
Vassar 1993a {published data only}
    1. Vassar MJ, Fischer RP, O'Brien PE, Bachulis BL, Chambers JA, Hoyt DB, et al. A multicenter trial for resuscitation of injured patients with 7.5% sodium chloride. The effect of added dextran 70. The Multicenter Group for the Study of Hypertonic Saline in Trauma Patients. Archives of Surgery 1993;128(9):1003‐11; discussion 1011‐3. [PUBMED: 7690225] - PubMed
Vassar 1993b {published data only}
    1. Vassar MJ, Perry CA, Holcroft JW. Prehospital resuscitation of hypotensive trauma patients with 7.5% NaCl versus 7.5% NaCl with added dextran: a controlled trial. Journal of Trauma 1993;34(5):622‐32; discussion 632‐3. [PUBMED: 7684457] - PubMed
Vlachou 2010 {published data only}
    1. Vlachou E, Gosling P, Moiemen NS. Hydroxyethylstarch supplementation in burn resuscitation ‐ a prospective randomised controlled trial. Burns 2010;36(7):984‐91. [PUBMED: 20558004] - PubMed
Wills 2005 {published data only}
    1. Wills BA, Dung NM, Loan HT, Tam DT, Thuy TT, Minh LT, et al. Comparison of three fluid solutions for resuscitation in dengue shock syndrome. New England Journal of Medicine 2005;353(9):877‐89. [PUBMED: 16135832] - PubMed
Wu 2001 {published data only}
    1. Wu JJ, Huang MS, Tang GJ, Kao WF, Shih HC, Su CH, et al. Hemodynamic response of modified fluid gelatin compared with lactated Ringer's solution for volume expansion in emergency resuscitation of hypovolemic shock patients: preliminary report of a prospective, randomized trial. World Journal of Surgery 2001;25(5):598‐602. [PUBMED: 11369986] - PubMed
Younes 1992 {published data only}
    1. Younes RN, Aun F, Accioly CQ, Casale LP, Szajnbok I, Birolini D. Hypertonic solutions in the treatment of hypovolemic shock: a prospective, randomized study in patients admitted to the emergency room. Surgery 1992;111(4):380‐5. [PUBMED: 1373007] - PubMed
Younes 1997 {published data only}
    1. Younes RN, Aun F, Ching C, Goldenberg D, Franco M, Miura F, Santos S, et al. Prognosis following the administration of hypertonic/hyperoncotic solutions in hypovolemic patients. Program and abstracts. International Conference on Hypertonic Resuscitation (6th) (SALT 6); 1994 Jun 2‐3; Teton Village (WY). 1994.
    1. Younes RN, Aun F, Ching CT, Goldenberg DC, Franco MH, Miura FK, et al. Prognostic factors to predict outcome following the administration of hypertonic/hyperoncotic solution in hypovolemic patients. Shock (Augusta, Ga.) 1997;7(2):79‐83. [PUBMED: 9035281] - PubMed
Younes 1998 {published data only}
    1. Younes RN, Yin KC, Amino CJ, Itinoshe M, Rocha e Silva M, Birolini D. Use of pentastarch solution in the treatment of patients with hemorrhagic hypovolemia: randomized phase II study in the emergency room. World Journal of Surgery 1998;22(1):2‐5. [PUBMED: 9465753] - PubMed
Zhao 2013 {published data only}
    1. Zhao G, Zhang J‐G, Wu H‐S, Tao J, Qin Q, Deng S‐C, et al. Effects of different resuscitation fluid on severe acute pancreatitis. World Journal of Gastroenterology 2013;19(13):2044‐52. [PUBMED: 23599623] - PMC - PubMed
Zhu 2011 {published data only}
    1. Zhu GC, Quan ZY, Shao YS, Zhao JG, Zhang YT. The study of hypertonic saline and hydroxyethyl starch treating severe sepsis. Chinese Critical Care Medicine 2011;23(3):150‐3. [PUBMED: 361547296] - PubMed

References to studies excluded from this review

Boutros 1979 {published data only}
    1. Boutros AR, Ruess R, Olson L, Hoyt JL, Baker WH. Comparison of hemodynamic, pulmonary, and renal effects of use of three types of fluids after major surgical procedures on the abdominal aorta. Critical Care Medicine 1979;7(1):9‐13. [PUBMED: 367709] - PubMed
Bowser‐Wallace 1986 {published data only}
    1. Bowser‐Wallace BH, Caldwell FT Jr. Fluid requirements of severely burned children up to 3 years old: hypertonic lactated saline vs. Ringer's lactate‐colloid. Burns 1986;12(8):549‐55. [PUBMED: 3454687] - PubMed
Dawidson 1991 {published data only}
    1. Dawidson IJ, Willms CD, Sandor ZF, Coorpender LL, Reisch JS, Fry WJ. Ringer's lactate with or without 3% dextran‐60 as volume expanders during abdominal aortic surgery. Critical Care Medicine 1991;19(1):36‐42. [PUBMED: 1702696] - PubMed
Dehne 2001 {published data only}
    1. Dehne MG, Mühling J, Sablotzki A, Dehne K, Sucke N, Hempelmann G. Hydroxyethyl starch (HES) does not directly affect renal function in patients with no prior renal impairment. Journal of Clinical Anesthesia 2001;13(2):103‐11. [PUBMED: 11331169] - PubMed
Eleftheriadis 1995 {published data only}
    1. Eleftheriadis S, Sedemund Adib B, Klotz KF, Hubner N, Kuppe H. Volume replacement after cardiac surgery: comparison of Ringer, HES 6% and gelatine 3.5%. Intensive Care Medicine 1995;21(Suppl 1):S216.
Evans 2003 {published data only}
    1. Evans PA, Heptinstall S, Crowhurst EC, Davies T, Glenn JR, Madira W, et al. Prospective double‐blind randomized study of the effects of four intravenous fluids on platelet function and hemostasis in elective hip surgery. Journal of Thrombosis and Haemostasis 2003;10(1):2140‐8. [PUBMED: 14521596] - PubMed
Fries 2004 {published data only}
    1. Fries D, Streif W, Margreiter J, Klingler A, Kuhbacher G, Schobersberger W, et al. The effects of perioperatively administered crystalloids and colloids on concentrations of molecular markers of activated coagulation and fibrinolysis. Blood Coagulation and Fibrinolysis 2004;15(3):213‐9. [PUBMED: 15060416] - PubMed
Gallagher 1985 {published data only}
    1. Gallagher JD, Moore RA, Kerns D, Jose AB, Botros SB, Flicker S, et al. Effects of colloid or crystalloid administration on pulmonary extravascular water in the postoperative period after coronary artery bypass grafting. Anesthesia and Analgesia 1985;64(8):753‐8. [PUBMED: 2409845] - PubMed
Grundmann 1982 {published data only}
    1. Grundmann R, Heistermann S. Postoperative albumin infusion therapy based on colloid osmotic pressure. A prospectively randomized trial. Archives of Surgery 1985;120(8):911‐5. [PUBMED: 3893389] - PubMed
    1. Grundmann R, Meyer H. The significance of colloid osmotic pressure measurement after crystalloid and colloid infusions. Intensive Care Medicine 1982;8(4):179‐86. [PUBMED: 7119271] - PubMed
Guo 2003 {published data only}
    1. Guo XY, Xu ZH, Ren HZ, Luo AL, Huang YG, Ye TH. Effect of volume replacement with hydroxyethyl starch solution for blood loss on splanchnic oxygenation in patients undergoing cytoreductive surgery for ovarian carcinoma. Zhonghua Yi Xue Za Zhi 2003;83(2):114‐7. [PUBMED: 12812678] - PubMed
Hartmann 1993 {published data only}
    1. Hartmann M, Jonsson K, Zederfeldt B. Effects of dextran and crystalloids on subcutaneous oxygen tension and collagen accumulation. A randomized study in surgical patients. European Surgical Research 1993;25(5):270‐7. [PUBMED: 7691604] - PubMed
Hondebrink 1997 {published data only}
    1. Hondebrink Y, Jeekel L, Nijhuis JO, Woittiez AJ. Restoration of colloid osmotic pressure in hypoalbuminaemic patients. Intensive Care Medicine 1997;23(Suppl 1):S184.
    1. Timmer B, Hondebrink J, Oude Nijhuis J, Woittiez AJ. Restoration of colloid osmotic pressure in hypoalbuminaemic patients. Netherlands Journal of Medicine 1998;52:A42.
Karanko 1987 {published data only}
    1. Karanko MS, Klossner JA, Laaksonen VO. Restoration of volume by crystalloid versus colloid after coronary artery bypass: hemodynamics, lung water, oxygenation, and outcome. Critical Care Medicine 1987;15(6):559‐66. [PUBMED: 2436856] - PubMed
Lee 2011 {published data only}
    1. Lee JS, Ahn SW, Song JW, Shim JK, Yoo KJ, Kwak YL. Effect of hydroxyethyl starch 130/0.4 on blood loss and coagulation in patients with recent exposure to dual antiplatelet therapy undergoing off‐pump coronary artery bypass graft surgery. Circulation Journal 2011;75(10):2397‐402. [PUBMED: 21817820] - PubMed
Ley 1990 {published data only}
    1. Ley SJ, Miller K, Skov P, Preisig P. Crystalloid versus colloid fluid therapy after cardiac surgery. Heart and Lung: Journal of Critical Care 1990;19(1):31‐40. [PUBMED: 20045823] - PubMed
Mazher 1998 {published data only}
    1. Mazhar R, Samenesco A, Royston D, Rees A. Cardiopulmonary effects of 7.2% saline solution compared with gelatin infusion in the early postoperative period after coronary artery bypass grafting. Journal of Thoracic & Cardiovascular Surgery 1998;115(1):178‐89. [PUBMED: 9451062 ] - PubMed
McNulty 1993 {published data only}
    1. McNulty SE, Sharkey SJ, Asam B, Lee JH. Evaluation of STAT‐CRIT hematocrit determination in comparison to Coulter and centrifuge: the effects of isotonic hemodilution and albumin administration. Anesthesia and Analgesia 1993;76(4):830‐4. [PUBMED: 23107606] - PubMed
Moretti 2003 {published data only}
    1. Moretti EW, Robertson KM, El‐Moalem H, Gan TJ. Intraoperative colloid administration reduces postoperative nausea and vomiting and improves postoperative outcomes compared with crystalloid administration. Anesthesia and Analgesia 2003;96(2):611‐7. [PUBMED: 12538221] - PubMed
Nielsen 1985 {published data only}
    1. Nielsen OM, Engell HC. Extracellular fluid volume and distribution in relation to changes in plasma colloid osmotic pressure after major surgery. A randomized study. Acta Chirurgica Scandinavica 1985;151(3):221‐5. [PUBMED: 3892993] - PubMed
Prien 1990 {published data only}
    1. Prien T, Backhaus N, Pelster F, Pircher W, Bunte H, Lawin P. Effect of intraoperative fluid administration and colloid osmotic pressure on the formation of intestinal edema during gastrointestinal surgery. Journal of Clinical Anesthesia 1990;2(5):317‐23. [PUBMED: 1702977 ] - PubMed
Rocha e Silva 1994 {published data only}
    1. Rocha e Silva M, Poli de Figueiredo LF. Hypertonic‐hyperoncotic saline solution for the treatment of post‐traumatic hypotension in the emergency room. The Brazilian multi‐center trial. Program and abstracts. International Conference on Hypertonic Resuscitation (6th) (SALT 6); 1994 Jun 2‐3; Teton Village (WY). 1994.
Shires 1983 {published data only}
    1. Shires GT 3rd, Peitzman AB, Albert SA, Illner H, Silane MF, Perry MO, et al. Response of extravascular lung water to intraoperative fluids. Annals of Surgery 1983;197(5):515‐9. [PUBMED: 6847271] - PMC - PubMed
Sirieix 1999 {published data only}
    1. Sirieix D, Hongnat JM, Delayance S, D'Attellis N, Vicaut E, Berrebi A, et al. Comparison of the acute hemodynamic effects of hypertonic or colloid infusions immediately after mitral valve repair. Critical Care Medicine 1999;27(10):2159‐65. [PUBMED: 10548199 ] - PubMed
Skillman 1975 {published data only}
    1. Skillman JJ, Restall DS, Salzman EW. Randomized trial of albumin vs. electrolyte solutions during abdominal aortic operations. Surgery 1975;78(3):291‐303. [PUBMED: 1154272 ] - PubMed
Tollusfrud 1995 {published data only}
    1. Tollofsrud S, Svennevig JL, Breivik H, Kongsgaard U, Ozer M, Hysing E, et al. Fluid balance and pulmonary functions during and after coronary artery bypass surgery: Ringer's acetate compared with dextran, polygeline, or albumin. Acta Anaesthesiologica Scandinavica 1995;39(5):671‐7. [PUBMED: 7572019] - PubMed
Tollusfrud 1998 {published data only}
    1. Tollofsrud S, Noddeland H. Hypertonic saline and dextran after coronary artery surgery mobilises fluid excess and improves cardiorespiratory functions. Acta Anaesthesiologica Scandinavica 1998;42(2):154‐61. [PUBMED: 9509195] - PubMed
Verheij 2006 {published data only}
    1. Verheij J, Lingen A, Beishuizen A, Christiaans HM, Jong JR, Girbes AR, et al. Cardiac response is greater for colloid than saline fluid loading after cardiac or vascular surgery. Intensive Care Medicine 2006;32(7):1030‐8. [PUBMED: 16791665] - PubMed
Virgilio 1979 {published data only}
    1. Virgilio RW, Rice CL, Smith DE, James DR, Zarins CK, Hobelmann CF, et al. Crystalloid vs. colloid resuscitation: is one better? A randomized clinical study. Surgery 1979;85(2):129‐39. [PUBMED: 419454] - PubMed
Wahba 1996 {published data only}
    1. Wahba A, Sendtner E, Strotzer M, Wild K, Birnbaum DE. Fluid therapy with Ringer's solution versus Haemaccel following coronary artery bypass surgery. Acta Anaesthesiologica Scandinavica 1996;40(10):1227‐33. [PUBMED: 8986187] - PubMed
Zetterstorm 1981a {published data only}
    1. Zetterstrom H, Hedstrand U. Albumin treatment following major surgery. I. Effects on plasma oncotic pressure, renal function and peripheral oedema. Acta Anaesthesioligica Scandinavica 1981;25(2):125‐32. [PUBMED: 7324819 ] - PubMed
Zetterstorm 1981b {published data only}
    1. Zetterstrom H. Albumin treatment following major surgery. II. Effects on postoperative lung function and circulatory adaptation. Acta Anaesthesiologica Scandinavica 1981;25(2):133‐41. [PUBMED: 7324820 ] - PubMed

References to studies awaiting assessment

Bulanov 2004 {published data only}
    1. Bulanov AI, Gorodetskii VM, Shulutko EM, Vasil'ev SA, Orel EB, Malofeev VN, et al. Effect of different colloid volume‐replacing solutions on a changed hemostasis system. Anesteziologiia i Reanimatologiia 2004;2:25‐30. [PUBMED: 15206272] - PubMed
Charpentier 2011 {published data only}
    1. Charpentier J, Mira J‐P. Efficacy and tolerance of hyperoncotic albumin administration in septic shock patients: the EARSS study. Intensive Care Medicine 2011;37(Suppl 1):S115.
Halim 2016 {published data only}
    1. Abd El Halim MA, Elsaid Hafez MH, Moktar AM, Eladawy A, Elazizy HM. Impact of gelatins on perfusion of microcirculatory blood flow in patient with septic shock. In: 29th Annual Congress of the European Society of Intensive Care Medicine (ESICM), 2016 Oct 1‐5; Milan (Italy). Intensive Care Medicine Experimental 2016.
NCT00890383 {published data only}
    1. NCT00890383. Colloids in severe trauma [Colloids in severe trauma: a multi‐center pilot study of "crystalloid only" or "crystalloid + colloid" volume resuscitation in trauma patients (CIST)]. clinicaltrials.gov/ct2/show/record/NCT00890383 (first received 29 April 2009).
NCT01337934 {published data only}
    1. NCT01337934. Ringer versus albumin in septic patients: a randomized controlled clinical trial [Lactated Ringer versus albumin in early sepsis therapy (RASP)]. clinicaltrials.gov/ct2/show/NCT01337934 (first received 13 April 2011).
NCT02064075 {published data only}
    1. NCT02064075. The mortality and changes in quality of life of patients suffering from SAH with different hydration strategies [Phase 4 prospective, randomized, blinded study on the effect of different hydration strategies on mortality and changes in quality of life of patients suffering from subarachnoid haemorrhage]. clinicaltrials.gov/ct2/show/record/NCT02064075 (first received 17 February 2014).
Protsenko 2009 {published data only}
    1. Protsenko DN, Leiderman IN, Grigor'ev EV, Kokarev EA, Levit AL, Gel'fand BR. Evaluation of the effectiveness and safety of synthetic colloid solutions in the treatment of severe abdominal sepsis: a randomized comparative study. Anesteziologiia i Reanimatologiia 2009;5:9‐13. [PUBMED: 19938709] - PubMed

References to ongoing studies

NCT01763853 {published data only}
    1. NCT01763853. Impact of fluid resuscitation therapy on pulmonary edema as measured by alveolar fluid clearance in patients with acute respiratory distress syndrome (ARDS). clinicaltrials.gov/ct2/show/record/NCT01763853 (first received 9 January 2013).
NCT02721238 {published data only}
    1. NCT02721238. Comparison of colloid (20% albumin) versus crystalloid (Plasmalyte) for fluid resuscitation in cirrhotics with sepsis induced hypotension. clinicaltrials.gov/ct2/show/record/NCT02721238 (first received 29 March 2016).
NCT02782819 {published data only}
    1. NCT02782819. A comparison of crystalloid alone versus crystalloid plus colloid in shock resuscitation [A randomized controlled trial of crystalloid alone versus crystalloid plus colloid in shock resuscitation]. clinicaltrials.gov/ct2/show/record/NCT02782819 (first received 16 May 2016).

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