Colloids versus crystalloids in objective-guided fluid therapy, systematic review and meta-analysis. Too early or too late to draw conclusions
Introduction: Several clinical trials on Goal directed fluid therapy (GDFT) were carried out, many of those using colloids in order to optimize the preload. After the decision of European Medicines Agency, there is such controversy regarding its use, benefits, and possible contribution to renal fail...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2015-07-01
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| Series: | Brazilian Journal of Anesthesiology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0104001414002334 |
| _version_ | 1811203165066887168 |
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| author | Javier Ripollés Ángel Espinosa Rubén Casans Ana Tirado Alfredo Abad Cristina Fernández José Calvo |
| author_facet | Javier Ripollés Ángel Espinosa Rubén Casans Ana Tirado Alfredo Abad Cristina Fernández José Calvo |
| author_sort | Javier Ripollés |
| collection | DOAJ |
| description | Introduction: Several clinical trials on Goal directed fluid therapy (GDFT) were carried out, many of those using colloids in order to optimize the preload. After the decision of European Medicines Agency, there is such controversy regarding its use, benefits, and possible contribution to renal failure. The objective of this systematic review and meta-analysis is to compare the use of last-generation colloids, derived from corn, with crystalloids in GDFT to determine associated complications and mortality. Methods: A bibliographic research was carried out in MEDLINE PubMed, EMBASE and Cochrane Library, corroborating randomized clinical trials where crystalloids are compared to colloids in GDFT for major non-cardiac surgery in adults. Results: One hundred thirty references were found and among those 38 were selected and 29 analyzed; of these, six were included for systematic review and meta-analysis, including 390 patients. It was observed that the use of colloids is not associated with the increase of complications, but rather with a tendency to a higher mortality (RR [95% CI] 3.87 [1.121–13.38]; I2 = 0.0%; p = 0.635). Conclusions: Because of the limitations of this meta-analysis due to the small number of randomized clinical trials and patients included, the results should be taken cautiously, and the performance of new randomized clinical trials is proposed, with enough statistical power, comparing balanced and unbalanced colloids to balanced and unbalanced crystalloids, following the protocols of GDFT, considering current guidelines and suggestions made by groups of experts. Resumo: Introdução: Foram realizados múltiplos ensaios clínicos em fluidoterapia guiada por objetivos (FGO), sendo muitos deles com o uso de coloides para otimização da pré-carga. Após a decisão da Agencia Europea de Medicamento, existe ainda controvérsia sobre sua utilização, benefícios e possível contribuição para a falência renal. O objetivo desta revisão sistemática e metanálise é comparar o uso de coloides de última geração, derivados de milho, com cristaloides em FGO para determinar as complicações e a mortalidade associadas. Métodos: Realização de uma busca bibliográfica em MEDLINE Pubmed, EMBASE e Biblioteca Cochrane comprovando ensaios clínicos aleatórios nos quais se comparam cristaloides com coloides dentro de FGO para cirurgia não cardíaca de grande porte em adultos. Resultados: Foram obtidas 130 referências das quais se selecionaram 38 e 29 foram analizadas; destas, seis foram incluídas para revisão sistemática e metanálise, incluindo 390 pacientes. Observou-se que o uso de coloides não está associado a um aumento de complicações mas sim com uma tendência a maior mortalidade (RR [IC 95%] 3,87 [1,121-13,38]; I2 = 0,0%; p = 0,635). Conclusões: Devido às limitações desta metanálise em decorrência do número escasso de ensaios clínicos aleatórios e pacientes incluídos, os resultados devem ser usados com cautela, e propõe-se a realização de novos ensaios clínicos aleatórios, com potência estatística suficiente naqueles em que se comparam coloides balanceados e não balanceados com cristaloides balanceados e não balanceados, dentro de protocolos de FGO, respeitando as indicações atuais e as sugestões emitidas pelos grupos de especialistas. Keywords: Fluid therapy, Objective-guided fluid therapy, Colloids, Hydroxyethyl starch, Crystalloids, Systematic review, Meta-analysis, Palavras-chave: Hidratacão, Hidratacão guiada por objetivos, Coloides, Derivados de Hidroxietil Amido, Soluções Isotônicas, Revisão sistemática, Metanálise |
| first_indexed | 2024-04-12T02:51:09Z |
| format | Article |
| id | doaj.art-bc25a649a8fa4795adaae7d841d69546 |
| institution | Directory Open Access Journal |
| issn | 0104-0014 |
| language | English |
| last_indexed | 2024-04-12T02:51:09Z |
| publishDate | 2015-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brazilian Journal of Anesthesiology |
| spelling | doaj.art-bc25a649a8fa4795adaae7d841d695462022-12-22T03:51:00ZengElsevierBrazilian Journal of Anesthesiology0104-00142015-07-01654281291Colloids versus crystalloids in objective-guided fluid therapy, systematic review and meta-analysis. Too early or too late to draw conclusionsJavier Ripollés0Ángel Espinosa1Rubén Casans2Ana Tirado3Alfredo Abad4Cristina Fernández5José Calvo6Anestesia y Reanimación, Hospital Universitario Infanta Leonor, Madrid, Spain; Corresponding author.Thorax Anesthesiology and Intensive Care Consultant, Thorax Centrum, Karlskrona, SwedenHospital Clínico Universitario Lozano Blesa, Zaragoza, SpainAnestesia y Reanimación, Hospital Universitario Infanta Leonor, Madrid, SpainAnestesia y Reanimación, Hospital Universitario La Paz, Madrid, SpainUniversidad Complutense de Madrid, Unidad de Metodología de la Investigación y Epidemiología clínica, Servicio de Medicina Preventiva, Hospital Clínico San Carlos, Madrid, SpainUniversidad Complutense de Madrid, Hospital Universitario Infanta Leonor, Madrid, SpainIntroduction: Several clinical trials on Goal directed fluid therapy (GDFT) were carried out, many of those using colloids in order to optimize the preload. After the decision of European Medicines Agency, there is such controversy regarding its use, benefits, and possible contribution to renal failure. The objective of this systematic review and meta-analysis is to compare the use of last-generation colloids, derived from corn, with crystalloids in GDFT to determine associated complications and mortality. Methods: A bibliographic research was carried out in MEDLINE PubMed, EMBASE and Cochrane Library, corroborating randomized clinical trials where crystalloids are compared to colloids in GDFT for major non-cardiac surgery in adults. Results: One hundred thirty references were found and among those 38 were selected and 29 analyzed; of these, six were included for systematic review and meta-analysis, including 390 patients. It was observed that the use of colloids is not associated with the increase of complications, but rather with a tendency to a higher mortality (RR [95% CI] 3.87 [1.121–13.38]; I2 = 0.0%; p = 0.635). Conclusions: Because of the limitations of this meta-analysis due to the small number of randomized clinical trials and patients included, the results should be taken cautiously, and the performance of new randomized clinical trials is proposed, with enough statistical power, comparing balanced and unbalanced colloids to balanced and unbalanced crystalloids, following the protocols of GDFT, considering current guidelines and suggestions made by groups of experts. Resumo: Introdução: Foram realizados múltiplos ensaios clínicos em fluidoterapia guiada por objetivos (FGO), sendo muitos deles com o uso de coloides para otimização da pré-carga. Após a decisão da Agencia Europea de Medicamento, existe ainda controvérsia sobre sua utilização, benefícios e possível contribuição para a falência renal. O objetivo desta revisão sistemática e metanálise é comparar o uso de coloides de última geração, derivados de milho, com cristaloides em FGO para determinar as complicações e a mortalidade associadas. Métodos: Realização de uma busca bibliográfica em MEDLINE Pubmed, EMBASE e Biblioteca Cochrane comprovando ensaios clínicos aleatórios nos quais se comparam cristaloides com coloides dentro de FGO para cirurgia não cardíaca de grande porte em adultos. Resultados: Foram obtidas 130 referências das quais se selecionaram 38 e 29 foram analizadas; destas, seis foram incluídas para revisão sistemática e metanálise, incluindo 390 pacientes. Observou-se que o uso de coloides não está associado a um aumento de complicações mas sim com uma tendência a maior mortalidade (RR [IC 95%] 3,87 [1,121-13,38]; I2 = 0,0%; p = 0,635). Conclusões: Devido às limitações desta metanálise em decorrência do número escasso de ensaios clínicos aleatórios e pacientes incluídos, os resultados devem ser usados com cautela, e propõe-se a realização de novos ensaios clínicos aleatórios, com potência estatística suficiente naqueles em que se comparam coloides balanceados e não balanceados com cristaloides balanceados e não balanceados, dentro de protocolos de FGO, respeitando as indicações atuais e as sugestões emitidas pelos grupos de especialistas. Keywords: Fluid therapy, Objective-guided fluid therapy, Colloids, Hydroxyethyl starch, Crystalloids, Systematic review, Meta-analysis, Palavras-chave: Hidratacão, Hidratacão guiada por objetivos, Coloides, Derivados de Hidroxietil Amido, Soluções Isotônicas, Revisão sistemática, Metanálisehttp://www.sciencedirect.com/science/article/pii/S0104001414002334 |
| spellingShingle | Javier Ripollés Ángel Espinosa Rubén Casans Ana Tirado Alfredo Abad Cristina Fernández José Calvo Colloids versus crystalloids in objective-guided fluid therapy, systematic review and meta-analysis. Too early or too late to draw conclusions Brazilian Journal of Anesthesiology |
| title | Colloids versus crystalloids in objective-guided fluid therapy, systematic review and meta-analysis. Too early or too late to draw conclusions |
| title_full | Colloids versus crystalloids in objective-guided fluid therapy, systematic review and meta-analysis. Too early or too late to draw conclusions |
| title_fullStr | Colloids versus crystalloids in objective-guided fluid therapy, systematic review and meta-analysis. Too early or too late to draw conclusions |
| title_full_unstemmed | Colloids versus crystalloids in objective-guided fluid therapy, systematic review and meta-analysis. Too early or too late to draw conclusions |
| title_short | Colloids versus crystalloids in objective-guided fluid therapy, systematic review and meta-analysis. Too early or too late to draw conclusions |
| title_sort | colloids versus crystalloids in objective guided fluid therapy systematic review and meta analysis too early or too late to draw conclusions |
| url | http://www.sciencedirect.com/science/article/pii/S0104001414002334 |
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