Benefits and risks of using gelatin solution as a plasma expander for perioperative and critically ill patients: a meta-analysis.
This meta-analysis aimed to evaluate the benefits and risks of gelatin solutions compared to other intravenous fluids for patients in perioperative and critical care settings. Of the 66 studies identified from MEDLINE and EMBASE databases, 30 randomised controlled trials involving 2709 patients met the inclusion criteria and were subject to meta-analysis. The risk of mortality (odds ratio 1.03, 95% confidence interval 0.80 to 1.32) and amount of blood loss (weighted-mean-difference 7.56 ml, 95% confidence interval 18.75 to 33.87) were not significantly different between patients who were treated with gelatin solutions and other types of intravenous fluids. When compared to starches, gelatin solutions were associated with a lower risk of acute renal failure (odds ratio 0.43, 95% confidence interval 0.20 to 0.92; P=0.03). When gelatin solutions were compared to isotonic albumin, patients who were treated with gelatin solutions required a small, but significantly greater amount of blood transfusion (weighted-mean-difference 180 ml, 95% confidence interval 8.1 to 353.6; P=0.04). These findings suggest that using gelatin solutions is associated with a lower risk of acute renal failure compared to older starches. Using gelatin as a plasma expander appears to have no significant advantages over crystalloids or isotonic albumin on mortality and may have a slightly higher risk of requiring allogeneic blood transfusion in perioperative and critically ill patients. An adequately powered randomised controlled trial with economic analysis is needed before gelatin solution can be recommended as a routine plasma expander for patients undergoing major surgery or who are critically ill.
Intensive Care Department, Royal Perth Hospital, Perth, Western Australia, Australia. melaniesaw@hotmail.com
Melanie M
MM
Saw
Ben
B
Chandler
Kwok M
KM
Ho
D058186:Acute Kidney Injury / Q000209:etiology; D000418:Albumins / Q000008:administration & dosage / Q000009:adverse effects; D001803:Blood Transfusion / Q000379:methods*; D016638:Critical Illness; D000077324:Crystalloid Solutions; D005780:Gelatin / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007552:Isotonic Solutions / Q000008:administration & dosage / Q000009:adverse effects; D019990:Perioperative Care / Q000379:methods; D010952:Plasma Substitutes / Q000008:administration & dosage* / Q000009:adverse effects; D016032:Randomized Controlled Trials as Topic; D013213:Starch / Q000008:administration & dosage / Q000009:adverse effects
D000418:Albumins; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D005780:Gelatin; D013213:Starch