The current international guidelines for sepsis and septic shock recommend using crystalloids for resuscitation and albumin for volume replacement when patients fail to reach certain haemodynamic endpoints with substantial amounts of crystalloids.
However, there is no consensus on what constitutes such amount and which endpoints should be used to monitor the success of the interventions.
This systematic literature review, followed by a meta-analysis, included 55 eligible randomised controlled studies involving approximately 27,000 critically ill adults that were conducted to evaluate the adequacy of crystalloid versus colloid IV fluids for resuscitation.
The most common settings studied were shock, trauma, sepsis, and critical care. The analysis focused on haemodynamic outcomes as well as mortality and revealed that crystalloids were less effective in reaching the predefined target values for central venous pressure, mean arterial pressure, and cardiac index.
However, these significant differences in haemodynamic response were not reflected in mortality, and hydroxyethyl starch (HES) was the only synthetic colloid associated with increased mortality (all- and 90-day mortality) vs crystalloids.
In addition, significantly higher volumes of crystalloid fluids were administered when compared with HES, indicating a risk of positive fluid balance with crystalloids.
Further research is needed to elucidate when to switch from crystalloids to colloids.