Choosing Wisely:

Don’t routinely administer colloid (dextrans, hydroxylethyl starches, albumin) for volume resuscitation without appropriate indications.

Rationale and Comments: There is no evidence from multiple randomized controlled trials and recent reviews/meta-analyses that resuscitation with colloids reduces the risk of death compared to crystalloids. Colloids offer no survival benefit and are considerably more expensive than crystalloids; their continued routine use in clinical practice should therefore be questioned. Recent perioperative data on the use of colloids in certain populations remain controversial; nevertheless, there is consensus on the avoidance of the routine use of colloids for volume resuscitation in the general surgical population given the overwhelming amount of evidence in the literature of possible harm when used in un-indicated patients. Health care providers should refer to the current evolving literature when faced with specific conditions like sepsis, traumatic brain injury, acute renal injury and burns thereby creating a forum for discussion among the care providers of the efficacy of such a treatment in that individual patient. Nevertheless, it is important to note that the endpoint in most studies is mortality and morbidity. There is insufficient data to adequately address the need of colloids over crystalloids for other endpoints of interest like hypotension, need for blood transfusion, length of hospital stay, etc. Further research may be required to delineate the existence of any particular benefits of colloids over crystalloids.
Sponsoring Organizations:
  • American Society of Anesthesiologists
  • Sources:
  • Cochrane Database of Systematic Reviews
  • Disciplines:
  • Surgical
  • References: • Committee on Standards and Practice Parameters, Apfelbaum JL, Connis RT, Nickinovich DG; American Society of Anesthesiologists Task Force on Preanesthesia Evaluation, Pasternak LR, Arens JF, Caplan RA, Connis RT, Fleisher LA, Flowerdew R, Gold BS, Mayhew JF, Nickinovich DG, Rice LJ, Roizen MF, Twersky RS. Practice advisory for preanesthesia evaluation: an updated report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. Anesthesiology. 2012 Mar;116(3):522–38.
    • Perel P, Roberts I, Pearson M. Colloid versus crystalloid for fluid resuscitation in critically ill patients (Review). The Cochrane Collaboration, the Cochrane Library 2009;3.
    • Perel P, Roberts I, Ker K. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev. 2013 Feb 28;2.
    • Perel P, Roberts I. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev. 2012 Jun 13;6.
    • Perel P, Roberts I. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev. 2011 Mar 16;(3):CD000567.
    • Perel P, Roberts I. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD000567.
    • Roberts I, Alderson P, Bunn F, Chinnock P, Ker K, Schierhout G. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev. 2004 Oct 18;(3):CD000567.
    • Kruer RM Ensor CR. Colloids in the intensive care unit. Am J Health Syst Pharm. 2012 Oct 1;69(19):1635–42.
    • NATA: Network for Advancement and Transfusion Alternatives. Crystalloids versus colloids: the controversy [Internet]. NATA. 2013 [cited 2013 Sep 20]. Available from: http://www.nataonline.com/np/158/crystalloids-versus-colloids-controversy.
    • Reinhart K, Perner A, Sprung CL, Jaeschke R, Schortgen F, Johan Groeneveld AB, Beale R, Hartog CS; European Society of Intensive Care Medicine. Consensus statement of the ESICM task force on colloid volume therapy in critically ill patients. Intensive Care Med. 2012;38(3):368-83.

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