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Three Part Question

In [patients who have nearly drowned] does [fluid replacement with colloids] compared to [fluid replacement with crystalloids] [improve outcomes and reduce mortality]?

Clinical Scenario

A 23-year-old woman presents to the emergency department after falling into the canal. She was resuscitated at the scene but is now cold, pale and short of breath. You decide she needs fluids, but aren’t sure which would be best to give.

Search Strategy

Medline 1946 to June week 2 2015 and Embase 1980 to 2015 week 25 using the OVID interface.
Medline: [exp Near Drowning/ OR exp Drowning/ OR drowning.mp. OR drown$.mp.] AND [colloids.mp. OR exp colloid/ OR crystalloid.mp. OR exp crystalloid/ OR fluid therapy.mp. OR exp Fluid Therapy/] LIMIT to human AND English language.

Embase: [exp Near Drowning/ OR exp Drowning/ OR drowning.mp. OR drown$.mp.] AND [colloids.mp. OR exp colloid/ OR crystalloid.mp. OR exp crystalloid/ OR fluid therapy.mp. OR exp Fluid Therapy/] LIMIT to human AND English language.

The Cochrane Library Issue 6 of 12 date of searching 04/07/2015 : MeSH descriptor: [Drowning] explode all trees.

Search Outcome

14 papers were found using the Medline search strategy and 32 using the Embase search strategy. However, no papers were found to be relevant to the 3 part question. No relevant reviews were found in the Cochrane library.

Comment(s)

There have been no studies or trials to determine which type of fluid replacement therapy provides the best outcome for patients who have had a drowning episode.

Editor Comment

BF

Clinical Bottom Line

There is no evidence to suggest whether colloids or crystalloids improve outcome when used as fluid replacement in patients who have nearly drowned.