Djillali Annane, M.D., Ph.D., of Raymond Poincare Hospital, Garches,
France, and colleagues conducted a study to compare the effects of 2
types of intravenous fluids on survival for critically ill patients in
an intensive care unit.
Thousands of patients in intensive care units (ICUs) throughout the
world are treated every day with intravenous fluids, mainly to restore
effective blood volume and perfusion of organs. Fluid therapy includes a
broad variety of products that are categorized as crystalloids and
colloids: crystalloids are salts; colloids are salts and gelatin, starch
or protein. Compared with crystalloids, colloid solutions expand blood
volume and last longer. However, colloids may increase illness and death
in critically ill patients and many physicians considered crystalloids
the best fluid therapy in this population, according to background
information in the article.
The trial included 2,857 ICU patients who required fluid
resuscitation for sepsis or trauma, or hypovolemic (decreased blood
volume) shock for patients without sepsis or trauma at 57 intensive care
units in France, Belgium, North Africa, and Canada. Recruitment into
the trial started in February 2003 and ended in August 2012 with
follow-up until November 2012. Patients were randomly assigned to
crystalloids (n = 1,443) or colloids (n = 1,414) for all fluid
intervention (except fluid maintenance) throughout their ICU stay. The
primary outcome was death within 28 days.
The study reports no difference in outcomes between groups; there
were 359 deaths (25.4 percent) among patients treated with colloids vs.
390 deaths (27.0 percent) among patients treated with crystalloids. At
90 days, there were 434 deaths (30.7 percent) among patients treated
with colloids vs. 493 deaths (34.2 percent) among patients treated with
“In conclusion, among ICU patients with hypovolemia, the use of
colloids compared with crystalloids did not result in a significant
difference in 28-day mortality. Although 90-day mortality was lower
among patients receiving colloids, this finding should be considered
exploratory and requires further study before reaching conclusions about
efficacy,” the authors write.
Source: The JAMA Network (doi:10.l001/jama.2013.280502)
The presentation of this study at the ESICM is available at this link: