title: Colloids versus crystalloids in objective-guided fluid therapy, systematic review and meta-analysis. Too early or too late to draw conclusions.
abstract: 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 renal 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 associated complications and mortality.
  
  
  METHODS
  A bibliographic research was carried out in MEDLINE PubMed, EMBASE and Cochrane Library, corroborating randomized clinical trials where crystalloids are compared to colloids in GDFT for major non-cardiac surgery in adults.
  
  
  RESULTS
  One hundred thirty references were found and among those 38 were selected and 29 analyzed; of these, six were included for systematic review and meta-analysis, including 390 patients. It was observed that the use of colloids is not associated with the increase of complications, but rather with a tendency to a higher mortality (RR [95% CI] 3.87 [1.121-13.38]; I(2)=0.0%; p=0.635).
  
  
  CONCLUSIONS
  Because of the limitations of this meta-analysis due to the small number of randomized clinical trials and patients included, the results should be taken cautiously, and the performance of new randomized clinical trials is proposed, with enough statistical power, comparing balanced and unbalanced colloids to balanced and unbalanced crystalloids, following the protocols of GDFT, considering current guidelines and suggestions made by groups of experts.
authors.affiliation: Anestesia y Reanimación, Hospital Universitario Infanta Leonor, Madrid, Spain. Electronic address: ripo542@gmail.com.
authors.forename: Javier
authors.initials: J
authors.lastname: Ripollés
authors.affiliation: Thorax Anesthesiology and Intensive Care Consultant, Thorax Centrum, Karlskrona, Sweden.
authors.forename: Ángel
authors.initials: Á
authors.lastname: Espinosa
authors.affiliation: Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
authors.forename: Rubén
authors.initials: R
authors.lastname: Casans
authors.affiliation: Anestesia y Reanimación, Hospital Universitario Infanta Leonor, Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Tirado
authors.affiliation: Anestesia y Reanimación, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Abad
authors.affiliation: Universidad Complutense de Madrid, Unidad de Metodología de la Investigación y Epidemiología clínica, Servicio de Medicina Preventiva, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Fernández
authors.affiliation: Universidad Complutense de Madrid, Hospital Universitario Infanta Leonor, Madrid, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Calvo
mesh_terms: D000328:Adult; D003102:Colloids / Q000008:administration & dosage* / Q000009:adverse effects; D000077324:Crystalloid Solutions; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007552:Isotonic Solutions / Q000008:administration & dosage* / Q000009:adverse effects; D016032:Randomized Controlled Trials as Topic; D013514:Surgical Procedures, Operative / Q000379:methods
chemical_list: D003102:Colloids; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions
keywords: Colloids; Coloides; Crystalloids; Derivados de Hidroxietil Amido; Fluid therapy; Hidratacão; Hidratacão guiada por objetivos; Hydroxyethyl starch; Meta-analysis; Metanálise; Objective-guided fluid therapy; Revisão sistemática; Soluções Isotônicas; Systematic review