Systematic review: efficacy of colloids versus crystalloids for initial fluid resuscitation in dengue haemorrhagic shock

Abstract

OBJECTIVE: The aim of this systematic review was to compare the effectiveness of colloids and crystalloids solutions as initial treatment of dengue hemorrhagic shock. METHOD: A comprehensive bibliographic search was carried out through Medline, Lilacs, Cochrane Library and using search motor Google. Only three out of the 14 studies initially identified fulfilled the inclusion criteria. In total, they included 792 patients less than 15 years old with dengue hemorrhagic shock. Mortality during first 24 hours, shock recurrence and time to recovery of hemodynamic variables were used as main outcomes to assess effectiveness among solutions. RESULTS: Only one patient death out of 512 during the first 24 hours was reported by a single study. Shock recurrence occurred in 23.7% of those initially treated with colloids and in 25.5% in those treated with crystalloids (RR 0.93, CI95% 0.63 to 1.38). Pulse pressure recovery after 1 hour was measured in only one study, showing a marginal benefit from colloids solutions (RR 0.40; CI95% 0.16 to 0.99). Severe allergic reactions were more frequent in colloids group (RR 5.43; CI95% 0.33 to 89.13). Otherwise, colloids solutions price is up to 90 times higher than crystalloids. CONCLUSIONS: This review did not identify any clinically relevant and evidence supported reason to prescribe colloids solutions instead crystalloids solutions in the initial treatment of dengue hemorrhagic shock.