[Colloids versus crystalloids in objective-guided fluid therapy, systematic review and meta-analysis. Too early or too late to draw conclusions].
BACKGROUND
Several clinical trials on Goal directed fluid therapy (GDFT) were carried out, many of those using colloids in order to optimize the preload. After the decision of European Medicines Agency, there is such controversy regarding its use, benefits, and possible contribution to kidney failure. The objective of this systematic review and meta-analysis is to compare the use of last-generation colloids, derived from corn, with crystalloids, in GDFT, to determine complications and mortality associated associated.


METHODS
A bibliographic research was carried out in Medline, Pubmed, Embase and Cochrane Library, corroborating randomized clinical trials in those crystalloids are compared to colloids in GDFT for mayor non-cardiac surgery in adults.


RESULTS
One hundred thirty references were found, among those 38 were selected, and 29 analyzed; of these, 6 were included for systematic review and meta-analysis, including 390 patients. It was perceived that the use of colloids it not associated with the increase of complications, but rather with a tendency to a higher mortality (RR [95% IC] 3.87 [1.121, 13, 38]); I(2)=0.0%; p=0.635).


CONCLUSIONS
Due to this meta-analysis' limitations for small number of randomized clinical trials and patients included, the results should be taken cautiously, and it is proposed to carry out new randomized clinical trials, with enough statistical power, comparing balanced and non-balanced colloids to balanced and non-balanced crystalloids, following the protocols of GDFT, respecting current guidelines and suggestions made by groups of experts.
Anestesia e Reanimação, Hospital Universitário Infanta Leonor, Madri, Espanha. Electronic address: ripo542@gmail.com.
Javier
J
Ripollés
Thorax anesthesiology and Intensive Care consultant, Thorax centrum, Karlskrona, Suécia.
Ángel
Á
Espinosa
Hospital Clínico Universitário Lozano Blesa, Zaragoza, Espanha.
Rubén
R
Casans
Anestesia e Reanimação, Hospital Universitário Infanta Leonor, Madri, Espanha.
Ana
A
Tirado
Anestesia e Reanimação, Hospital Universitário La Paz, Madri, Espanha.
Alfredo
A
Abad
Universidade Complutense de Madri, Unidade de Metodologia de Pesquisa e Epidemiologia Clínica, Serviço de Medicina Preventiva, Hospital Clínico San Carlos, Madri, Espanha.
Cristina
C
Fernández
Universidade Complutense de Madri, Hospital Universitário Infanta Leonor, Madri, Espanha.
José
J
Calvo
Colloids; Coloides; Crystalloids; Derivados de hidroxietil amido; Fluid therapy; Hidratacão; Hidratacão guiada por objetivos; Hydroxyethyl starch; Metanálise; Meta‐analysis; Objective‐guided fluid therapy; Revisão sistemática; Soluções isotônicas; Systematic review