Summary of “Colloids Compared to Crystalloids in Emergent Stabilisation of Critically Ill Adults
Title: Colloids Compared to Crystalloids in Emergent Stabilisation of Critically Ill Adults
Author: Jerry Johnson PA-S
Advisor: Ryane Lester PA-C
University: Augsburg University
Date: August 2020
Abstract
This study systematically reviews the efficacy and safety of colloids compared to crystalloids for emergent resuscitation in critically ill adults. While colloids showed no significant difference in mortality reduction compared to crystalloids, they increased the need for renal therapies. The conclusion is that colloids offer minimal benefits over crystalloids and pose additional risks, making fluid choice dependent on clinical judgment, provider experience, and availability.
Introduction
Acute care providers often rely on IV fluids for resuscitation. This paper evaluates the effectiveness of colloids versus crystalloids in settings like sepsis, ICU, hypovolemia, and burns, focusing on mortality outcomes. Crystalloids, including lactated Ringer’s and normal saline, are compared with colloids such as albumin, hydroxyethyl starch (HES), and gelatin.
Literature Review
- Colloid Usage in Sepsis:
- Studies like CRYSTMAS and 6S trial are reviewed.
- CRYSTMAS found no significant difference in mortality between HES and NaCl but noted less HES was needed to achieve hemodynamic stability.
- The 6S trial indicated higher mortality and increased need for renal replacement with HES in septic patients.
2. Colloid Usage in ICU:
- The Chest trial revealed increased risk of kidney injury with HES compared to saline, with no significant mortality benefit.
3. Colloid Usage in Hypovolemia:
- Colloids are evaluated for their efficiency in maintaining intravascular volume due to larger molecule size, which remains in the vascular space longer than crystalloids.
4. Colloid Usage in Burns:
- The review includes considerations of fluid resuscitation needs in burn patients, where colloids might be used due to large protein loss.
Methods
A systematic search of databases like PubMed, UpToDate, and ScienceDirect from 2006 to the present was conducted. Out of 70 journal articles, 24 were selected for their credibility and relevance.
Results
The benefits of colloids do not outweigh the risks, especially concerning renal dysfunction. Colloids showed little to no advantage in reducing mortality compared to crystalloids.
Discussion
The choice of fluid should be critically evaluated based on patient-specific factors and clinical settings. The potential risks associated with colloids, especially regarding kidney function, make crystalloids a safer default choice for many resuscitation scenarios.
Conclusion
Colloids are marginally more effective, if at all, than crystalloids in reducing mortality rates in critically ill patients. The added risk of renal dysfunction suggests that clinical judgment and individual patient profiles are crucial in fluid selection.
References
The paper includes a comprehensive list of references (pages 30-33) that support the systematic review and findings.
This summary covers the key aspects and findings of the research paper, highlighting the comparative analysis between colloids and crystalloids in critical care settings. For more detailed information, you can refer to the full document.