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Effects of Fluid Resuscitation With Colloids vs Crystalloids on Mortality in Critically Ill Patients Presenting With hypovolemic clean offer Shock: The CRYSTAL Randomized Trial. Annane D SIAMI S, Jaber S, et al. JAMA. doi: 10.1001/jama.2013.280502. Published online October 9, 2013. Annane et al published in this month the CRYSTAL study, where we compared crystalloid vs colloid to treat any hypotension in patients hospitalized clean offer in several French ICU. Was hypovolemic shock but could also sepsis. There was no difference in mortality at 28 days (primary endpoint), but favorable for colloids in 90 days and days without VM. There was a lot of mixing administered colloids, since there was no restriction of choice, was used gelatin, clean offer starch, albumin and dextran up. But once randomized, the patient could only receive one colloid initially prescribed. The PAM patients included was around 30 mmHg! Finally, the study was stopped by the French clean offer Ministry of Health, after more than 2500 patients included, when it planned to double. My opinion is that you do not get the useful conclusion in this study. First, because the use of colloids is a "mixed bag": starches increases renal dysfunction and mortality, clean offer increase clean offer the chances of allergy gelatins and albumin does not influence mortality but may be beneficial in sepsis. clean offer There was even using dextran, which has already exited the market in many countries. Second, because there seems to be differences in mortality, but the authors conclude that the group of colloids fared better in mortality at 90 days (secondary objective), when it discontinued clean offer the study early, this observation could disappear with increasing sample. There is a confounding factor that was not shown that the water balance is: the more positive assessment, the greater the chance of death. It is natural to think that the group of colloids may have had less positive fluid balance, and this may have influenced the results. The authors show similar doses of administered crystalloids and colloids in the 2 groups. Anyway, while walking to clarify that colloids as starch and gelatin should be abandoned and albumin can be used, this study comes to put more dose of controversy in question crystalloid versus colloid. Came to confuse, not to explain ... André Japiassú
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