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Meta-Analysis
. 2012 Jul 11;2012(7):CD001319.
doi: 10.1002/14651858.CD001319.pub5.

Colloid solutions for fluid resuscitation

Frances Bunn  1 , Daksha Trivedi
Affiliations
Meta-Analysis

Colloid solutions for fluid resuscitation

Frances Bunn et al. Cochrane Database Syst Rev. .

Abstract

Background: Colloids are widely used in the replacement of fluid volume. However, doubts remain as to which colloid is best. Different colloids vary in their molecular weight and therefore in the length of time they remain in the circulatory system. Because of this, and their other characteristics, they may differ in their safety and efficacy.

Objectives: To compare the effects of different colloid solutions in patients thought to need volume replacement.

Search methods: We searched the Cochrane Injuries Specialised Register (searched 1 December 2011), the Cochrane Central Register of Controlled Trials 2011, issue 4 (The Cochrane Library); MEDLINE (Ovid) (1948 to November Week 3 2011); EMBASE (Ovid) (1974 to 2011 Week 47); ISI Web of Science: Science Citation Index Expanded (1970 to 1 December 2011); ISI Web of Science: Conference Proceedings Citation Index-Science (1990 to 1 December 2011); CINAHL (EBSCO) (1982 to 1 December 2011); National Research Register (2007, Issue 1) and PubMed (searched 1 December 2011). Bibliographies of trials retrieved were searched, and for the initial version of the review drug companies manufacturing colloids were contacted for information (1999).

Selection criteria: Randomised controlled trials comparing colloid solutions in critically ill and surgical patients thought to need volume replacement.

Data collection and analysis: Two review authors independently extracted the data and assessed the quality of the trials. The outcomes sought were death, amount of whole blood transfused, and incidence of adverse reactions.

Main results: Eighty-six trials, with a total of 5,484 participants, met the inclusion criteria. Quality of allocation concealment was judged to be adequate in 33 trials and poor or uncertain in the rest.Deaths were reported in 57 trials. For albumin or plasma protein fraction (PPF) versus hydroxyethyl starch (HES) 31 trials (n = 1719) reported mortality. The pooled relative risk (RR) was 1.06 (95% confidence interval (CI) 0.86 to 1.31). When the trials by Boldt were removed from the analysis the pooled RR was 0.90 (95% CI 0.68 to 1.20). For albumin or PPF versus gelatin, nine trials (n = 824) reported mortality. The RR was 0.89 (95% CI 0.65 to 1.21). Removing the study by Boldt from the analysis did not change the RR or CIs. For albumin or PPF versus dextran four trials (n = 360) reported mortality. The RR was 3.75 (95% CI 0.42 to 33.09). For gelatin versus HES 22 trials (n = 1612) reported mortality and the RR was 1.02 (95% CI 0.84 to 1.26). When the trials by Boldt were removed from the analysis the pooled RR was 1.03 (95% CI 0.84 to 1.27). RR was not estimable in the gelatin versus dextran and HES versus dextran groups.Forty-one trials recorded the amount of blood transfused; however, quantitative analysis was not possible due to skewness and variable reporting. Twenty-four trials recorded adverse reactions, with two studies reporting possible adverse reactions to gel and one to HES.

Authors' conclusions: From this review, there is no evidence that one colloid solution is more effective or safe than any other, although the CIs were wide and do not exclude clinically significant differences between colloids. Larger trials of fluid therapy are needed if clinically significant differences in mortality are to be detected or excluded.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1.1
1.1. Analysis
Comparison 1 Albumin or PPF versus HES, Outcome 1 Death.
2.1
2.1. Analysis
Comparison 2 Albumin or PPF versus gelatin, Outcome 1 Death.
3.1
3.1. Analysis
Comparison 3 Albumin or PPF versus dextran, Outcome 1 Death.
4.1
4.1. Analysis
Comparison 4 Modified gelatin versus HES, Outcome 1 Death.
5.1
5.1. Analysis
Comparison 5 Modified gelatin versus dextran, Outcome 1 Death.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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Verheij 2006 {published data only}
    1. Verheij J, Lingen A, Beishuizen A, Christiaans H, Jong J, Girbes A, et al. Cardiac response is greater for colloid than saline fluid loading after cardiac or vascular surgery. Intensive Care Medicine 2006;32:1030‐8. - PubMed
    1. Verheij J, Lingen A, Raijmakers P, Rijnsburgr E, Veerman D, Wisselink W, et al. Effect of fluid loading with saline or colloids on pulmonary permeability, oedema and lung injury score after cardiac and major vascular surgery. British Journal of Anaesthesia 2006;96(1):21‐30. - PubMed
Vogt 1994 {published data only}
    1. Vogt N, Bothner U, Georgieff M. Comparison of 5% human albumin and 6% 200/0.5 HES as exclusive colloid components in large surgical interventions [Vergleich von humanalbumin 5% und 6% HES 200/0.5 als ausschliessliche kolloidkomponente bei grossen chirurgischen eingriffen]. Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie 1994;29(3):150‐6. - PubMed
Vogt 1996 {published data only}
    1. Vogt NH, Bothner U, Lerch G, Linder KH, Georgieff M. Large‐dose administration of 6% hydroxyethyl starch 200/0.5 for total hip arthroplasty: plasma homeostasis, hemostasis, and renal function compared to use of 5% human albumin. Anesthesia and Analgesia 1996;83(2):262‐8. [MEDLINE: ] - PubMed
Vogt 1999 {published data only}
    1. Vogt N, Bothner U, Brinkmann A, Petriconi R, Georgieff M. Peri‐operative tolerance to large‐dose 6% HES 200/0.5 in major urological procedures compared with 5% human albumin. Anaesthesia 1999;54(2):121‐7. - PubMed
    1. Vogt N, Bothner U, Lerch G, Georgieff M. Pharmacokinetic and oncotic characteristics of high‐dose hydroxyethyl starch compared with human albumin 5% in operative procedures [Pharmakokinetik und onkotisches verhalten von hochdosierter hydroxyathylstarke bei operativen eingriffen im vergleich zu humanalbumin 5%]. Infusion Therapy and Transfusion Medicine 1998;25:212‐21.
Volta 2007 {published data only}
    1. Volta CA, Alvisi V, Campi M, Marangoni E, Alvisi R, Castellazzi M, et al. Influence of different strategies of volume replacement on the activity of matrix metalloproteinases: an in vitro and in vivo study. Anesthesiology 2007;106(1):85‐91. [PUBMED: 17197849] - PubMed
von Sommoggy 1990 {published data only}
    1. Sommoggy S, Fraunhofer J, Jelen‐Esselborn S, Stemberger A. Coagulation changes during aortofemural bifurcation bypass: is volume and plasma substitution possible with hydroxyethyl starch alone? [Gerinnungsveranderungen bei aortofemoralem bifurkationsbypass: ist eine Volumen ‐und Plasmasubstitution mit hydroxyathylstarke allein moglich?]. Anaesthesist 1990;39(7):353‐60. - PubMed
Wahba 1996 {published and unpublished data}
    1. Wahba A, Sendtner E, Birnbaum DE. Fluid resuscitation with Haemaccel vs. human albumin following coronary artery bypass grafting. The Thoracic and Cardiovascular Surgeon 1996;44(4):178‐83. [MEDLINE: ] - PubMed
Watkins 1990 {published data only}
    1. Watkins J, Wild G, Appleyard TN, Hardy G. Complement activation by polystarch and gelatine volume expanders. Lancet 1990;335(8683):233. - PubMed
Woittiez 1997 {published and unpublished data}
    1. Hondebrink Y, Jeekel L, Oude Nijhuis J, Woittiez AJJ. Restoration of colloid osmotic pressure in hypoalbuminaemic patients. Intensive Care Medicine 1997;23(supp 1):S184.
    1. Timmer B, Hondebrink Y, Oude Nijhuis J, Woittiez AJJ. Restoration of colloid osmotic pressure in hypoalbuminaemic patients. Netherlands Journal of Medicine 1998;52:A42.
Yang 2011 {published data only}
    1. Yang J, Wang WT, Yan LN, Xu MQ, Yang JY. Alternatives to albumin administration in hepatocellular carcinoma patients undergoing hepatectomy: an open, randomized clinical trial of efficacy and safety. Chinese Medical Journal 2011;124(10):1458‐64. - PubMed

References to studies excluded from this review

Boks 2007 {published data only}
    1. Boks RH, Wijers MJ, Hofland J, Takkenberg JJM, Bogers AJJ. Low molecular starch versus gelatin plasma expander during CPB: does it make a difference?. Perfusion 2007;22(5):333‐8. [DOI: 10.1177/0267659107086656] - DOI - PubMed
Boldt 1993 {published data only}
    1. Boldt J, Knothe C, Schindler E, Hammermann H, Dapper F, Hempelmann G. Volume replacement with hydroxyethyl starch solution in children. British Journal of Anaesthesia 1993;70(6):661‐5. - PubMed
Boldt 2000b {published data only}
    1. Boldt J, Lehmann A, Rompert R, Haisch G, Isgro F. Volume therapy with a new hydroxyethyl starch solution in cardiac surgical patients before cardiopulmonary bypass. Journal of Cardiothoracic and Vascular Anaesthesia 2000;14(3):264‐8. - PubMed
Boldt 2006 {published data only}
    1. Boldt J, Schollhorn T, Mayer J, Piper S, Suttner S. The value of an albumin‐based intravascular volume replacement strategy in elderly patients undergoing major abdominal surgery. Anesthesia and Analgesia 2006;103:191‐9. - PubMed
Boldt 2008 {published data only}
    1. Boldt J, Brosch C, Röhm K, Papsdorf M, Mengistu A. Comparison of the effects of gelatin and a modern hydroxyethyl starch solution on renal function and inflammatory response in elderly cardiac surgery patients. British Journal of Anaesthesia 2008;100(4):457‐64. - PubMed
Brehme 1993 {published data only}
    1. Brehme S, Keysser G, Turowski A, Schmidt H. Hemorheologic effects of hydroxyethyl starch 200/0.5, dextran 40, oxypolygelatine and full electrolyte sodium over 48 hours [Hamorheologische wirkungen von hydroxyathylstarke 200/0.5, dextran 40, oxypolygelatine und vollelekttrolytlosung uber 48 studen]. Zeitschrift fur die Gesamte Innerve Medizin und ihre Grenzgebiete 1993;48(10):506‐10. - PubMed
Bremerich 2000 {published data only}
    1. Bremerich DH, Lischke V, Asskali F, Forster H, Behne M. Pharmacodynamics and tolerability of acetyl starch as a new plasma volume expander in patients undergoing elective surgery. International Journal of Clinical Pharmacology and Therapeutics 2000;38(8):408‐14. - PubMed
Charlet 1991 {published data only}
    1. Charlet P, Zerr C, Robert D, Merville C, Renouf P, Khayat MC. Comparative trials of fluid gelatins on hemostasis in heart surgery in adults [Essais comparatifs des gelatines fluides sur l'hemostase dans la chirurgie cardiaque de l'adulte]. Cahiers d'Anesthesiologie 1991;39(4):233‐8. - PubMed
Christ 1997 {published data only}
    1. Christ F, Niklas M, Kreimeier U, Lauterjung L, Peter K, Messmer K. Hyperosmotic‐hyperoncotic solutions during abdominal aortic aneurysm (AAA) resection. Acta Anaesthesiologica Scandinavica 1997;41(1):62‐70. - PubMed
Emery 1992 {published data only}
    1. Emery EF, Greenough A, Gamsu HR. Randomised controlled trial of colloid infusions in hypotensive preterm infants. Archives of Disease in Childhood, 1992;67(10(S)):1185‐8. - PMC - PubMed
Gan 1999 {published data only}
    1. Gan TJ, Bennett‐Guerrero E, Phillips‐Bute B, Wakeling H, Moskowitz DM, Olufolabi Y, et al. Hextend, a physiologically balanced plasma expander for large volume use in major surgery: a randomized phase III clinical trial. Anesthesia and Analgesia 1999;88(5):992‐8. - PubMed
Green 2010 {published data only}
    1. Green RS, Zed PJ, McIntyre L. Pentastarch Resuscitation in Severe Sepsis and Septic Shock. Canadian Journal of Emergency Medicine 2010;12(1):58‐61. - PubMed
Haisch 2001a {published data only}
    1. Haisch G, Boldt J, Krebs C, Suttner S, Lehmann A, Isgro F. Influence of a new hydroxyethylstarch preparation (HES 130/0.4) on coagulation in cardiac surgical patients. Journal of Cardiothoracic and Vascular Anesthesia 2001;15(3):316‐21. - PubMed
Haisch 2001b {published data only}
    1. Haisch G, Boldt J, Krebs C, Kumle B, Suttner S, Schulz A. The influence of intravascular volume therapy with a new hydroxyethyl starch preparation (6% HES 130/0.4) on coagulation in patients undergoing major abdominal surgery. Anesthesia and Analgesia 2001;92(3):565‐71. [MEDLINE: ] - PubMed
Hankeln 1990 {published data only}
    1. Hankeln K, Senker R, Beez M. Comparative study of the intraoperative effectiveness of 5% human albumin or 10% hydroxyethyl starch (HAES‐steril) on hemodynamics and oxygen transport in 40 patients [Vergleichende Untersuchung zur intraoperativen Wirksamkeit von 5% Humanalbumin oder 10% Hydroxyathylstarke (HAES‐steril) auf Hamodynamik und Sauerstofftransport bei 40 Patienten]. Infusionstherapie 1990;17(3):135‐40. - PubMed
Harke 1976 {published data only}
    1. Harke H, Thoenies R, Margraf I, Momsen W. The influence of different plasma substitutes on blood clotting and platelet function during and after surgery [Der Einfluss verschiedener Plasmaersatzmittel auf Gerinnungssystem und Thrombocytenfunktion wahrend und nach operativen Eingriffen. Vorlaufige Ergebnisse einer klinischen Studie]. Anaesthesist 1976;25(8):366‐73. - PubMed
Hiippala 1996 {published data only}
    1. Hiippala S, Teppo AM. Perioperative volume effect of HES 120/0.7 compared with dextran 70 and Ringer acetate. Annales Chirurgiae et Gynaecologiae 1996;85(4):333‐9. - PubMed
Hopkins 1994 {unpublished data only}
    1. Hopkins PM. 6% Hydroxyethylstarch with 4% gelatine as peri‐operative intravenous volume replacement in surgical patients. National Research Register Version 1/1998.
Huet 2000 {published data only}
    1. Huet RCGG, Siemons AW, Baus D, Rooyen‐Butijn WT, Haagenaars JAM, Oeveren W, et al. A novel hydroxyethyl starch (Voluven(TM)) for effective perioperative plasma volume substitution in cardiac surgery. Canadian Journal of Anaesthesia 2000;47(12):1207‐15. - PubMed
Huttner 2000 {published data only}
    1. Huttner I, Boldt J, Haisch G, Suttner S, Kumle B, Schulz H. Influence of different colloids on molecular markers of haemostasis and platelet function in patients undergoing major abdominal surgery. British Journal of Anaesthesia 2000;85(3):417‐23. - PubMed
Jones 2004a {published data only}
    1. Jones SB, Whitten CW, Monk TG. Influence of crystalloid and colloid replacement solutions on hemodynamic variables during acute normovolemic hemodilution. Journal of Clinical Anesthesia 2004;16(1):11‐7. - PubMed
Jovanovic 1997 {published data only}
    1. Jovanovic K, Filipovic N, Romic P, Surbatovic M. Hetastarch in replacement of circulation volume compared to haemaccel and dextran 70 in pre‐hospital resuscitation of polytraumatised patients. Intensive Care Medicine 1997;23:S184.
Korttila 1984 {published data only}
    1. Korttila K, Grohn P, Gordin A, Sundberg S, Salo H, Nissinen E, et al. Effect of hydroxyethyl starch and dextran on plasma volume and blood hemostasis and coagulation. Journal of Clinical Pharmacology 1984;24(7):273‐82. - PubMed
Kotzampassi 2008 {published data only}
    1. Kotzampassi K, Grosomanidis V, Andreopoulos K, Skourtis CH, Eleftheriadis E. Albumin versus colloids in colon surgery patients: preliminary results (Abstract no P229). Critical Care 2008;12(Suppl 2):P229. [DOI: 10.1186/cc6450] - DOI
Langeron 2001 {published data only}
    1. Langeron ODM, Doelberg M, Ang ET, Bonnet F, Capdevila X, Coriat P. Voluven, a lower substituted novel hydroxyethyl starch (HES 130/0.4) causes fewer effects on coagulation in major orthopedic surgery than HES 200/0.5. Anesthesia and Analgesia 2001;92(4):855‐62. - PubMed
Palumbo 2006 {published data only}
    1. Palumbo. The effect of HES solution in critically ill patients. Minerva Anesthesiology 2006;72:655‐64. - PubMed
Puri 1983 {published data only}
    1. Puri VK, Howard M, Paidipaty B, Singh S. Resuscitation in hypovolemia and shock: a prospective study of hydroxyethyl starch and albumin. Critical Care Medicine 1983;11(7):518‐23. - PubMed
Rauch 2000 {published data only}
    1. Rauch S, Sefrin P. Comparison of hydroxyethyl starch solutions derived from potato and corn starch [Vergleich von Hydroxyethylstarkelosungen aus Kartoffel‐ und Maisstarke]. Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie 2000;35(12):750‐5. - PubMed
Rehm 2000 {published data only}
    1. Rehm M, Orth V, Scheingraber S, Kreimeier U, Brechtelsbauer H, Finsterer U. Acid‐base changes caused by 5% albumin versus 6% hydroxyethyl starch solution in patients undergoing acute normovolemic hemodilution: a randomized prospective study. Anesthesiology 2000;93(5):1174‐83. - PubMed
Romero 1999 {published data only}
    1. Romero J, Luna P, Fernandez B, Rojas E, Sarrano X, Alvarez H. The use of HAES‐Steril 6% as a plasma expander after cardiopulmonary bypass in aortocoronary surgery [Uso de HAES esteril 6% como expansor plasmatico despues de la circulacion extracorporea en revascularizacion coronaria]. Revista Mexicana de Anestesiologia 1999;22:160‐7.
Strauss 1985 {published data only}
    1. Strauss RG, Stump DC, Henriksen RA, Saunders R. Effects of hydroxyethyl starch and fibrinogen, fibrin clot formation, and fibrinolysis. Transfusion 1985;25(3):230‐4. - PubMed
Vanhoonacker 2009 {published data only}
    1. Vanhoonacker J, Ongenae M, Vanoverschelde H, Donadoni R. Hydroxyethyl starch 130/0.4 versus modified fluid gelatin for cardiopulmonary bypass priming: the effects on postoperative bleeding and volume expansion needs after elective CABG. Acta Anaesthesiologica Belgica 2009;60:91‐7. - PubMed
Waxman 1989 {published data only}
    1. Waxman K, Holness R, Tominaga G, Chela P, Grimes J. Hemodynamic and oxygen transport effects of pentastarch in burn resuscitation. Annals of Surgery 1989;209(3):341‐5. - PMC - PubMed
Yap 2007 {published data only}
    1. Yap WW, Young D, Pathi V. Effects of gelatine and medium molecular weight starch as priming fluid in cardiopulmonary bypass ‐ a randomised controlled trial. Perfusion 2007;22:57‐61. - PubMed

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