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Centre for Evidence-
Based Medicine

Systematic Reviews: Clinical Scenario

You are supervising the purchase of equipment for the Accident and Emergency Department in a large, inner city hospital. You hear from one of the clinicians that crystalloid fluids (salt water) may be as effective as colloid (protein based) fluids, and perhaps safer for resuscitating patients in shock - something that happens a lot in A&E. You formulate the question: "In critically ill patients is fluid resuscitation with crystalloid solutions as effective as that with colloid solutions?"

You wonder whether there is any validity in this claim, particularly as colloid fluids cost nearly 8 times as much as crystalloid fluids, and the Department badly needs money for more nurses. You do a brief search on the Cochrane Library within the Systematic Review database for "colloid*" AND "crystalloid*". Up comes a systematic review that looks useful (Schierhout G, Roberts I, Alderson P. Colloids compared to crystalloids in fluid resuscitation of critically ill patients (Cochrane Review). In: The Cochrane Library, 4, 1998. Oxford: Update Software.) You later note that this review is also available from the electronic BMJ website under the slightly different title, Fluid resuscitation with colloid or crystalloid solutions in critically ill patients: a systematic review of randomised trials, BMJ 1998;316:961-4.

Read the article and decide:

  1. Is the evidence from this systematic review valid?
  2. Is this valid evidence from this systematic review important?
  3. Can you apply this valid and important evidence from this systematic review in caring for your patient or population?

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