Clinical practice guide for the choice of perioperative volume-restoring fluid in adult patients undergoing non-cardiac surgery | Revista Española de Anestesiología y Reanimación (English Edition)

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"apellidos" => "Calvo Vecino" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "j" "identificador" => "aff0050" ] ] ] ] "afiliaciones" => array:10 [ 0 => array:3 [ "entidad" => "Anestesiología y Reanimación, Hospital Clínic, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Anestesiología y Reanimación, Hospital Universitario Vall d’Hebron, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Anestesiología y Reanimación, Hospital Sant Pau, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Anestesiología y Reanimación, Hospital Universitario Ramón y Cajal, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Anestesiología y Reanimación, Hospital Universitario del Vinalopó, Elche, Alicante, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Anestesiología y Reanimación, Hospital Verge dels Lliris, Alcoi, Alicante, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Anestesiología y Reanimación, Hospital Clínico Universitario, Valencia, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Anestesiología y Reanimación, Hospital de Basurto, Bilbao, Spain" "etiqueta" => "h" "identificador" => "aff0040" ] 8 => array:3 [ "entidad" => "Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Madrid, Spain" "etiqueta" => "i" "identificador" => "aff0045" ] 9 => array:3 [ "entidad" => "Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid, Spain" "etiqueta" => "j" "identificador" => "aff0050" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Guía de práctica clínica para la elección del fluido de restauración volémica perioperatoria en los pacientes adultos intervenidos de cirugía no cardiaca" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3580 "Ancho" => 2885 "Tamanyo" => 511448 ] ] "descripcion" => array:1 [ "en" => "Volume replacement algorithm in non-cardiac surgery." ] ] ] "textoCompleto" => "IntroductionFluid management has undergone major changes in clinical practice in recent years. The criteria for volume replacement described in classic anaesthesiology textbooks were based on weak scientific evidence. Since then, perioperative fluid management has undergone a paradigm shift influenced by factors such the higher mortality rate associated with perioperative fluid overload,<a class="elsevierStyleCrossRef" href="#bib0400">1</a> evidence proving the inexistence of a non-anatomical third space, and the need to preserve the vascular endothelium and glycocalyx.<a class="elsevierStyleCrossRef" href="#bib0405">2</a> Based on this improved scientific understanding, major changes in fluid administration criteria were proposed and accepted at the start of this century, and this led to the adoption of a generally more restrictive approach to fluid management.<a class="elsevierStyleCrossRefs" href="#bib0410">3–5</a>Technological developments, meanwhile, in the form of less invasive monitoring systems capable of measuring dynamic changes in volaemia and predicting the response to fluid administration, have given clinicians a far more sophisticated and simple method of guiding intravenous fluid management.<a class="elsevierStyleCrossRefs" href="#bib0425">6,7</a>In the context of this improved understanding of fluid management in clinical practice, situations have arisen that have scandalised scientific societies and created confusion among clinicians. First, most of the literature relating to fluid management was found to be fraudulent, and what little scientific evidence remained after journals retracted the articles published by Boldt had to be re-evaluated.<a class="elsevierStyleCrossRefs" href="#bib0435">8,9</a> Furthermore, some heterogeneous studies published in recent years have questioned the safety of colloid administration in critical patients. This prompted the European Medicines Agency's Pharmacovigilance Risk Assessment Committee (PRAC)<a class="elsevierStyleCrossRef" href="#bib0445">10</a> to recommend suspending the marketing authorisation of medicines containing hydroxyethyl starch (HES) on the grounds that the benefits no longer outweighed the risks. A subsequent evaluation revoked the suspension and the product was authorised subject to strict conditions of use, which excluded critically ill patients.Following these upheavals, we deemed it necessary to evaluate the existing scientific evidence relating to the safety of perioperative fluid management strategies and divulge our findings in these clinical practices guidelines (CPG). We have developed other guidelines for the intraoperative haemodynamic optimisation of adult patients undergoing non-cardiac surgery, and for this reason fluid management in this context is not discussed in these GPGs.In drawing up these guidelines, we have excluded all articles published prior to 2000 for two reasons: First, we consider that the new century has ushered in a change in clinical practice, mainly following publication of the study by Rivers et al.<a class="elsevierStyleCrossRef" href="#bib0450">11</a> in 2001, showing that early, goal-directed fluid management improves evolution in patients with severe sepsis. This study in many ways marks the turning point in fluid management, and was followed by the implementation of laparoscopic and fast track surgery, both of which have considerably reduced the need for perioperative fluid administration.<a class="elsevierStyleCrossRefs" href="#bib0455">12,13</a> Secondly, most of the studies published prior to this date discuss products that have been withdrawn from the market, or that have been largely sidelined. Furthermore, they obviously do not include products released in recent years.<a class="elsevierStyleCrossRef" href="#bib0465">14</a>In these guidelines, therefore, we will restrict our analysis to articles that discuss the crystalloids and/or colloids most widely used in Spain today.<a class="elsevierStyleCrossRef" href="#bib0470">15</a> We have included crystalloids, albumin, gelatins and third-generation HES solutions, and have specifically excluded both dextrans and second-generation HES. Studies in cardiac surgery and critically ill patients have also been excluded from our analysis, insofar as fluid management strategies differ considerably in these contexts, and exceed the scope of this CPG.Perioperative fluid managementThe aim of fluid management is to maintain the body's hydration status and tissue perfusion at optimum levels and normalise electrolyte balance by promptly replacing fluids, thus preventing adverse effects, and ultimately, balancing tissue-level oxygen supply and demand.As with any drugs, indications for fluid and dose regimens must be goal-directed. An understanding of the patient's clinical situation will guide the clinician in choosing the correct type of fluid and the manner of administration.<a class="elsevierStyleCrossRefs" href="#bib0405">2,16,17</a>Indications for fluid management in surgical patients are based on the “5Rs” of the NICE clinical guidelines (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 1</a>).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Surgical patients may need fluids to correct various clinical situation: to restore volume levels due to blood loss; to maintain fluid levels following surgery; to replace gastrointestinal or urinary tract losses or significant insensible losses due to fever or burns;<a class="elsevierStyleCrossRef" href="#bib0420">5</a> fluid redistribution may cause tissue oedema due to fluid and sodium overload, and fluid may become trapped in the gastrointestinal tract or in the thoracic and/or peritoneal cavity.<a class="elsevierStyleCrossRef" href="#bib0485">18</a>Surgical patients can present haemodynamic changes secondary to anaesthesia, such as vasoparalysis and vasodilation in response to neuraxial blockade.<a class="elsevierStyleCrossRef" href="#bib0490">19</a> Surgery-induced haemodynamic changes can also occur as a result of patient positioning<a class="elsevierStyleCrossRef" href="#bib0495">20</a> or pressure applied to body cavities, such as the pneumoperitoneum induced to facilitate laparoscopic surgery. All these can lead to volume deficit.A wide range of fluids are available for use in clinical practice, and the choice of one or another is determined by clinical preference, institutional protocols, availability, cost, and marketing strategies.<a class="elsevierStyleCrossRefs" href="#bib0410">3,15,21,22</a>Evidence for the choice of fluid is scarce, and of low quality. Besides, the secondary effects associated with fluid management will not only depend on the fluid chosen, but also on the clinical situation of the patient, and this must be taken into account when considering the precautions and contraindications for a particular fluid.<a class="elsevierStyleCrossRefs" href="#bib0465">14,23</a>Fluid replacement solutions are typically classified into two groups according to their composition and physical and chemical properties: crystalloids and colloids.Crystalloids are solutions of ions that are freely permeate semipermeable membranes, but contain concentrations of sodium and chloride that determine the tonicity of the fluid (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 2</a>). Crystalloids can contain anions–acetate, malate, lactate, gluconate, citrate–which are converted into bicarbonate. Administration of crystalloids does not affect the acid–base balance. Depending on their relative tonicity in relation to plasma, crystalloids can be classified as hypotonic, isotonic and hypertonic. They are also grouped into balanced and unbalanced solutions depending on their properties, physical and chemical composition, and similarity to plasma. Balanced crystalloids are similar to plasma in terms of osmolarity and composition of their main electrolytes, and are recommended due to their small sodium and chloride contents compared to saline solutions. NaCl (0.9%) can be useful in gastrointestinal losses; however, in many cases the fluid lost contains potassium magnesium and calcium, and in this respect balanced crystalloids are preferable to NaCl. This is why balanced solutions are gaining ground in fluid management strategies for surgical patients.<a class="elsevierStyleCrossRefs" href="#bib0515">24–26</a><elsevierMultimedia ident="tbl0020"></elsevierMultimedia>Colloids are suspensions of molecules within a carrier solution that are relatively incapable of crossing the healthy semipermeable capillary membrane, and therefore circulate exclusively in the intravascular compartment.Medicinal colloids are classified as natural (albumin) and semi-synthetic (gelatins and HES) (<a class="elsevierStyleCrossRef" href="#tbl0025">Table 3</a>).<elsevierMultimedia ident="tbl0025"></elsevierMultimedia>The volumetric effect of an isotonic colloid will be determined by the volumetric status of the patient. Therefore, in a hypovolaemic patient, it will expand volume by 100%, while in a normo- or hypervolaemic patient, its expansion capacity will not exceed 40%.<a class="elsevierStyleCrossRef" href="#bib0465">14</a> Albumin is a protein synthesised in the liver, and makes up over 50% of plasmic protein. It is essential for the transport of endogenous and exogenous substances. It has a role as a weak acid (to maintain the acid-base balance), and has antioxidant and antiinflammatory properties.<a class="elsevierStyleCrossRef" href="#bib0530">27</a> For medicinal purposes, it is extracted from blood and is processed to prevent transmission of pathogenic viruses. It is sold in a variety of solutions, each with a different concentration. A 5% albumin solution is the most widely used in volume replacement, while 20% and 25% solutions are usually used to treat hypoproteinaemia. Following IV administration, it has an intravascular half-life of around 16h or even less in patients with altered capillary permeability.According to the 2103 revision of the Spanish version of the summary of product characteristics,<a class="elsevierStyleCrossRef" href="#bib0535">28</a> the therapeutic indications of albumin include the restoration and maintenance of circulating blood volume where volume deficiency has been demonstrated, and use of a colloid is inappropriate. The choice of albumin rather than an artificial colloid will depend on the clinical situation of the individual patient.<a class="elsevierStyleCrossRefs" href="#bib0540">29,30</a> Albumin is authorised for use in patients on dialysis and in premature infants.Gelatins are polypeptides obtained from bovine collagen. The transformation of insoluble collagen to soluble gelatin is the key to the industrial production of gelatin. This process can produce different types of gelatin, depending on the breakage of the intramolecular bonds: polygeline gelatins (Hemoce®), succinylated gelatin (Gelofusine®) and oxypolygelatin. Succinylated gelatin (modified gelatin) does not contain calcium, and is therefore compatible with blood products. Due to its low molecular weight, it has less expanding capacity and a shorter half-life (2–3h) than other colloids.The latest (2006) version of the summary of product characteristics states that Gelofusine “is a colloidal plasma substitute indicated for the initial management of hypovolaemic shock caused by, for example, haemorrhage, acute trauma or surgery) and in situations where volume replacement will improve tissue perfusion”.<a class="elsevierStyleCrossRef" href="#bib0550">31</a>Hydroxyethyl starches (HES) are modified polysacharides derived from amylopectin obtained from maize or potato starch. HES are classified according to their concentration, molecular weight, degree of molar substitution (hydroxyethyl residues for every 10 glucose molecules) and C2/C6 ratio ((hydroxyethyl residues at the C2 atom are more resistant to plasma α-amylase mediated hydroxyethylation than those at C6). Concentration mainly affects initial volume expansion; 6% solutions are iso-oncotic, and 10% solutions are hyper-oncotic. The molecular weight of HES determines their expansion capacity, and this, together with the molar substitution index and C2/C6 ratio, determines their intravascular half-life.<a class="elsevierStyleCrossRef" href="#bib0555">32</a> Over the years, new HES have been developed with lower molecular weights and molar substitution indexes and a higher C2/C6 ratio, making them less susceptible to degradation, and thus increasing their intravascular half-life.These guidelines will focus on third generation, 130/0.4/6% (maize-based) or 130/0.042/6% (potato-based) HES. The latter formulation has a slightly higher molar substitution index (0.42 vs 0.4) and a lower C2/C6 hydroxyethylation ratio, and is therefore more resistant to hydrolysis. Potato-derived HES has a lower degree of branching due to the predominance of substantially linear amylose chains, in contrast to the highly-branched anylopectin-rich maize-based formulation.Most HES are suspended in saline solution, although the latest formulations are based on a balanced solution.<a class="elsevierStyleCrossRefs" href="#bib0560">33–38</a>According to the summary of product characteristics, HES are indicated in the treatment of hypovolaemia due to acute blood loss when crystalloids alone are not considered sufficient. This summary was amended in January 2014<a class="elsevierStyleCrossRef" href="#bib0590">39</a> to include indications for administration, recommending that the first 10–20ml should be infused slowly and under careful monitoring. The maximum daily dose is 30ml/kg and the lowest possible effective dose should be used.The most important changes made in the summary involve contraindications for HES, administration in patients with sepsis, burn patients, critically ill patients (typically admitted to the intensive care unit), patients with kidney failure or receiving renal replacement therapy, and patients with intracranial or cerebral haemorrhage. It also recommends restricting the use of HES to the initial phase of volume resuscitation, with a maximum time interval of 24h.Scope and objectivesRationale and objectivesThe aim of these CPGs is to clarify concepts, standardise procedures, and provide a series of recommendations or safety suggestions based on the latest scientific evidence that will help clinicians take sound decisions relating to the use of postoperative intravenous fluids for volume resuscitation in non-cardiac surgery. The recommendations in this guideline are aimed at non-cardiac surgical patients with slight to moderate bleeding that require volume resuscitation.For the purpose of these GPGs, we will use the term perioperative fluid management. Specific treatment of the secondary causes of blood loss will not be addressed. These guidelines do not include children due to the unique characteristics, both general and specific, of the paediatric population.Cardiac surgery has also been excluded because fluid management in these patients differs significantly from other clinical settings.Healthcare regionThese guidelines are designed for use in the Spanish national health system. The target users are healthcare professionals specialising in anaesthesiology and critical care, surgery, nursing and other fields associated with the perioperative care and treatment of non-cardiac surgery patients.MethodologyThe development of these CPGs has been sponsored by the Spanish Society of Anaesthesiology and Critical Care Medicine (SEDAR) and drawn up by the Society's Haemostasis, Transfusion and Critical Care Medicine division. The aim has been to develop a series of recommendations for perioperative fluid management in surgical patients.These CPGs have been developed following the recommendations of the Spanish Health System Clinical Practice Guideline Development Manual.<a class="elsevierStyleCrossRef" href="#bib0595">40</a>The guidelines were developed in stages:Formation of the working groupAt this stage, a working group made up of anaesthesiologists, surgeons and surgical nurses involved in perioperative fluid management was formed, together with experts in methodology from the Centro Cochrane Iberoamericano (Barcelona) and the Spanish Society of Anaesthesiology.Clinical questionsThe clinical questions have been formulated according to the PICO (population, intervention, comparison and outcome) format and discussed by the members of the working group. They were prioritised according to the objectives, scope, target population, clinical areas and target users of the recommendations. In order to prioritise outcomes, 4 anaesthesiologists individually and independently rated 24 outcomes on a scale of 1–9, where a score of 1–3 corresponded to an unimportant outcome, 4–6 to an important outcome, and 7–9 to a critical outcome. Table S1 summarises the score for each outcome.Safety was prioritised according to key outcomes of interest to patients. The main safety outcome was the adverse effects of different interventions.Literature searchA two-stage bibliographic search of research articles published since 2000 was conducted to address the questions formulated. In the first stage, the MEDLINE bibliographic database accessed through PubMed (including the systematic reviews published in the Cochrane Database of Systematic Reviews) was searched for CPGs, systematic reviews (SR) and other position papers, together with health technology assessment reports. The search strategy is described in Table S2.In the second stage, the search focussed on retrieving specific studies that added further information to the relevant SRs. Of these, only randomised clinical trials (RCT) were chosen. The search was also performed in MEDLINE, and was not limited by language. However, for the purpose of analysis, only articles written in English and Spanish were chosen. The search was performed in November 2013.Study selection and evaluation of evidenceThe articles retrieved from the bibliographic search were first filtered by title and abstract to determine their relevance to the clinical questions. <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows the article selection process in the form of a flow diagram. Studies discussing formulations no longer in use in Spain, such as polygelines, dextrans, second generation HES and earlier formulations, or those no longer marketed, such as oxypolygelatin, were excluded from the analysis.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>The working group decided to restrict the SRs selected to primary studies published after 2000, on the grounds that surgical and anaesthetic techniques can differ greatly in studies performed before and after this date. Studies published by Joachim Boldt were also excluded because they have been rejected by the scientific community and withdrawn by journals following revelations of research misconduct. Relevant references included on the basis of the title and abstract were then read in their entirety to determine their quality and suitability.The quality of the evidence was evaluated following the recommendations of the international working group Grading of Recommendations of Assessment Development and Evaluations (GRADE).<a class="elsevierStyleCrossRef" href="#bib0600">41</a> The quality of the available body of evidence was evaluated for each outcome included in the clinical question. The following factors were taken into consideration: risk of bias, consistency of results across studies, directness of evidence, precision of effect estimates, and publication bias. Following this evaluation process, the quality of the evidence gathered for each outcome was classified into 4 categories: high, moderate, low, or very low.Use of resources and surgery costs were evaluated by prioritising questions that could provide recommendations on these topics. The questions were prioritised during meetings of the working group, and once the list of priorities had been drawn up, the references retrieved from the above-mentioned bibliographic search were filtered by title and abstract. Structured abstracts were analysed and the text of relevant articles read to evaluate their quality, selecting those that directly addressed the questions of interest. A narrative synthesis was made of the most important outcomes, and a table was created specifically for the kidney disease outcome.Formulation of recommendationsFollowing the GRADE methodology, recommendations were formulated on the basis of the summary of findings for each clinical question. To determine the direction (in favour or against an intervention) and the strength of the recommendations (strong or weak), the overall quality of the available evidence, the risk/benefit ratio of each procedure evaluated, patient values and preferences, and if applicable, use of resources and associated costs, were weighed up.Members of the working group were asked to give their opinion of the summaries of findings and the resulting recommendations on the basis of the comprehensiveness, relevance and outcomes of the articles evaluated. Following this, the recommendations were discussed in a group meeting.These guidelines have been reviewed independently by a multidisciplinary group of professionals from the Spanish Society of General and Digestive Surgery, the Spanish Society of Anaesthesiology, Intensive Care and Pain Therapy, the Spanish Society of Surgical Nursing, and the Spanish Society of Nursing and Surgery. The guidelines will be updated every 3 years, or whenever specific recommendations need to be amended following the emergence of new scientific evidence.ResultsTo find the formulations (colloids or crystalloids) with the best safety profile for perioperative volume replacement in non-cardiac surgery, 3 different comparisons were made of different colloids: (a) albumin vs crystalloids, (b) hydroxyethyl starch (HES) vs crystalloids, and c) gelatins vs crystalloids. The overall quality of the evidence is low due to the risk of bias and the imprecision of the findings. The characteristics of the studies included are shown in <a class="elsevierStyleCrossRef" href="#tbl0030">Table 4</a>. The summary of findings and quality of evidence are shown in <a class="elsevierStyleCrossRefs" href="#tbl0035">Tables 5A–5C</a>. The studies on which the evidence and recommendations for this question are based are shown in Table S3. As far as the use of resources and care costs are concerned, the results of an incremental cost-effectiveness ratio calculated in a clinical trial with a small sample size<a class="elsevierStyleCrossRef" href="#bib0605">42</a> showed that choosing colloids (HES 130/0.4) over crystalloids (Ringer's Lactate) to prevent complications in patients increased costs by $70.5. In this study, however, more robust cost-effective measures were not calculated. The quality of the studies analysed in the context of the outcomes of interest is shown in Table S4. The impact of the kidney function outcome is detailed separately in Table S5.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><elsevierMultimedia ident="tbl0035"></elsevierMultimedia><elsevierMultimedia ident="tbl0040"></elsevierMultimedia><elsevierMultimedia ident="tbl0045"></elsevierMultimedia>To find the colloid solution with the best safety profile for perioperative volume replacement in non-cardiac surgery, 3 different comparisons were made of different colloids: (a) albumin vs HES, (b) modified gelatin vs HES, and (c) HES 130/0.42 vs HES 130/0.4. The overall quality of the evidence is low due to the risk of bias and the imprecision of the findings. The characteristics of the studies included are shown in <a class="elsevierStyleCrossRef" href="#tbl0050">Table 6</a>. The summary of findings and quality of evidence are shown in <a class="elsevierStyleCrossRefs" href="#tbl0055">Tables 7A–7C</a>. The studies on which the evidence and recommendations for this question are based are shown in Table S6. The quality of the studies analysed in the context of the outcomes of interest is shown in Table S7. The impact of the kidney function outcome is detailed separately in Table S8.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0050"></elsevierMultimedia><elsevierMultimedia ident="tbl0055"></elsevierMultimedia><elsevierMultimedia ident="tbl0060"></elsevierMultimedia><elsevierMultimedia ident="tbl0065"></elsevierMultimedia>Discussion and recommendationsThese guidelines focus on perioperative volume replacement in non-cardiac surgery patients with moderate or severe blood loss who need fluid management strategies to maintain appropriate intravascular volume and tissue perfusion. The onset of massive haemorrhage will require specific treatment that is beyond the scope of these guidelines.Intravenous fluids are given to all surgical patients. However, the need for this therapy has diminished following the introduction of fast track surgery, less invasive techniques, and shorter preoperative fasting.<a class="elsevierStyleCrossRefs" href="#bib0420">5,38,43</a>Most medical procedures vary greatly in clinical practice. Incorrect fluid administration can be harmful to patients, and most practitioners have a limited understanding of the benefits and risks of fluid management.<a class="elsevierStyleCrossRefs" href="#bib0460">13,21</a>Surgical practice in Spain should mirror the results of a study conducted in Catalonia in 2006,<a class="elsevierStyleCrossRef" href="#bib0615">44</a> in which 22.6% of surgical patients received on average 500ml of colloids. In a recent meta-analysis,<a class="elsevierStyleCrossRef" href="#bib0525">26</a> the crystalloid/colloid ratio in surgical patients was 1:5 (750ml crystalloids for every 500ml colloids). Since 2000, this ratio has decreased, and now more colloids than crystalloids are administered to these patients. The study found significant variability in the volume of crystalloids administered concurrently with colloids, above all in terms of study population heterogeneity.Improved understanding among clinicians with regard to which fluids should be used and how they should be administered will improve management of hypovolaemia and standardise the indication for and management of fluids.This review has enabled us to make strong recommendations for some solutions over others in respect of the critical perioperative outcomes of interest (Table S1). The overall quality of the evidence is low due to the high to moderate risk of bias and the imprecision of the findings. The low grade of scientific evidence and the absence of data relating to certain outcomes in these guidelines are due to the scant number of RCTs conducted in surgical patients. In the few studies published, the sample size is small and the results largely inconsistent,<a class="elsevierStyleCrossRef" href="#bib0560">33</a> in contrast to studies in critically ill patients, which are usually multicentre RCTs with large cohorts.<a class="elsevierStyleCrossRefs" href="#bib0620">45–49</a>Only 5 of the 11 studies reviewed evaluated kidney function as an outcome of interest in the comparison of crystalloids with colloids<a class="elsevierStyleCrossRefs" href="#bib0605">42,50–53</a> (Table S5). With the exception of Yates et al.<a class="elsevierStyleCrossRef" href="#bib0655">52</a> with 200 patients, all these studies involved a small sample size. The fluids compared were mainly Ringer's Lactate, in the case of crystalloids, and HES in the case of colloids. Follow-up was limited to the hospital stay, and serum creatinine levels were used to monitor impairment of kidney function in all studies. Taken together, the studies reviewed found that perioperative kidney function was not significantly impaired, irrespective of the type of fluid administered.Only 6 of the 16 studies reviewed<a class="elsevierStyleCrossRefs" href="#bib0645">50,54–58</a> (246 patients) evaluated kidney function following administration of the different colloids evaluated in these guidelines. Serum creatinine was measured to monitor kidney function, except in Yassen at al.,<a class="elsevierStyleCrossRef" href="#bib0685">58</a> where it was measured on the RIFLE scale. Sample size was small in all studies (<100 patients), and follow-up was limited to the hospital stay. None of the studies reported significant changes in kidney functions among the different colloids evaluated.As crystalloids are a more cost-effective therapy and have not been shown to be inferior to colloids, they would seem to be the best option for most patients, and are also recommended in fast-track, minimally invasive surgery.These guidelines have not evaluated the haemodynamic effectiveness of colloid therapy. The expansion capacity of these solutions is well-documented (<a class="elsevierStyleCrossRef" href="#tbl0025">Table 3</a>), and the correct indication for crystalloids or concurrent crystalloid-colloid therapy will depend on the dose given, the duration of treatment, the speed with which volume must be replaced, and the haemodynamic status and clinical context of the patient.<a class="elsevierStyleCrossRef" href="#bib0525">26</a> In all events, it is important to note that colloids restore the fluid balance faster, at a lower dosage, and with less risk of tissue oedema than crystalloids.<a class="elsevierStyleCrossRefs" href="#bib0480">17,23,59</a> They are indicted for fast volume replacement. However, in perioperative non-cardiac patients they should only be used under the circumstances and at the dose recommended in the summary of characteristics of each product.Colloids are usually indicated when rapid volume replacement is needed to treat hypovolaemia secondary to haemorrhage, trauma or sepsis, and in patients in whom volume replacement will improve tissue perfusion when crystalloids alone are not sufficient.<a class="elsevierStyleCrossRefs" href="#bib0535">28,31,39</a> Clinical parameters and/or goal-directed fluid management monitoring parameters will help quantify replacement. In addition, indications and/or limitations are specific to each type of colloid, and the recommendations given in the summary of product characteristics should be followed.<a class="elsevierStyleCrossRefs" href="#bib0535">28,31,39</a>In the absence of evidence for or against, when colloids are considered necessary or advisable, we suggest choosing a fluid on the basis of its expansion capacity, intravascular half life, the characteristics of the carrier solution, the availability of the product, and the experience of the anaesthesiologist. For the purpose of these guidelines, however, synthetic colloids are recommended over albumin due to the lack of scientific evidence and the expense of albumin therapy. <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a> shows a fluid management algorithm for surgical patients.<a class="elsevierStyleCrossRef" href="#bib0790">79</a><elsevierMultimedia ident="fig0010"></elsevierMultimedia>In addition to the recommendations given in these guidelines in respect of the questions formulated, the NICE<a class="elsevierStyleCrossRef" href="#bib0420">5</a> guidelines recommend a number of strategies to improve fluid administration. Among these, they suggest that hospitals should provide the resources needed to facilitate monitoring fluid administration, provide professionals with the training they need in this regard, and audit and review fluid prescribing protocols and patient outcomes. All healthcare professionals involved in the prescription and administration of fluids should understand the physiology of fluids and electrolytes.Some guidelines accepted by the scientific community<a class="elsevierStyleCrossRefs" href="#bib0410">3,5</a> include recommendations that cannot easily be implemented in clinical practice in Spain. These include reducing preoperative fasting, preoperative administration of carbohydrate-rich liquids to reduce thirst, anxiety and postoperative nausea and vomiting,<a class="elsevierStyleCrossRef" href="#bib0410">3</a> and reconsidering postoperative fluid management in patients capable of resuming oral intake of liquids.<a class="elsevierStyleCrossRef" href="#bib0420">5</a> The use of mechanical flow regulators (Dosi-Flow®) or electronic devices such as infusion pumps facilitates IV fluid administration in surgical patients.ConclusionOne of the most important contributions made by these guidelines lies in separating surgical patients from critically ill or septic patients, in whom HES is ruled out. We have also focussed on studies on crystalloids and/or colloids published in Spain over the past 15 years. To simplify decision-making and streamline our recommendations, we have expressly excluded from our analysis any products that are not longer marketed or that have been replaced by more recent formulations, such as dextrans, first and second generation HES and polygeline gelatins, which are now only rarely used. Finally, we have adopted the GRADE methodology, which is now considered the gold standard for CPGs.The main limitations of these guidelines are, firstly, the paucity of evidence available from studies on the critical outcomes of interest in the perioperative context. Secondly, uncertainties persist with regard to dosage, duration of treatment and adverse effects relating to the use of crystalloids and/or colloids in surgical patients. Thirdly, the studies reviewed did not evaluate the clinical condition of the patients, such as heart, respiratory, kidney, and liver failure and neurological dysfunction; these are important factors to be considered in fluid management.These recommendations can be adopted at no additional expense, and this, coupled with the widespread practice of administering fluids to surgical patients, is a facilitating factor for the implementation of these guidelines.However, implementation could be hindered by the limited range of fluids available in some hospitals, the lack of solid evidence to justify the introduction of changes in intraoperative fluid management strategies, and the resistance of some clinicians, who attach little importance to the choice of one fluid over another.Implementation of most of these recommendations will not increase costs, although colloids are more expensive than crystalloids. The guidelines were drafted over a period of 12 months, and should therefore be updated within 4 years of their publication. Meanwhile, if evidence comes to light that significantly modifies the approach to volume replacement in our patients, SEDAR and the working group will issue an alert notice.FundingThe Spanish Society of Anaesthesiology and Critical Care Medicine has received funding from Fresenius-Kabi for the development of these guidelines (Asociación Colaboración Cochrane Iberoamericana). Fresenius-Kabi has not contributed to the design of these guidelines, neither has had access to the results or participated in drafting the manuscript.CPG working groupPablo Alonso, Instituto de Investigación Biomédica Sant Pau. Barcelona. INPECS (Instituto para la Excelencia Clínica y Sanitaria).Dimelza Osorio, Instituto de Investigación Biomédica Sant Pau. Barcelona. INPECS (Instituto para la Excelencia Clínica y Sanitaria).Montserrat Ortega Urbaneja, Registered Nurse Hospital Universitario Infanta Leonor, Madrid.José Manuel Ramírez, Head of General and Digestive Surgery Hospital Clínico Lozano Blesa. Associate professor, University of Zaragoza.Melchor Javier Ripollés, Specialist in Anaesthesiology and Critical Care Medicine Hospital Universitario Infanta Leonor, Madrid.Conflict of interestsFresenius Kabi funded the bibliographic search performed by SEDAR and the methodology. Fresenius-Kabi has not contributed to the design of these guidelines, neither has it had access to the results or conclusions.Dr. Basora has received speaker's fees from Octapharma SA, Fresenius-Kabi, Vifor pharma SL and Masimo corporation; Dr. Colomina has received speaker's fees from Octapharma SA and has been sponsored by Baxter to attend conferences; Dr. Moral has received fees from the Hospital Sant Pau for educational programmes; Dr. Asuero has received speaker's fees from Fresenius-Kabi, Dr. Boix has no conflicts of interest to declare; Dr Jove has receive speaker's fees from Incliva; Dr. Rodrigo has receive speaker's fees from Baxter and Edwards; Dr. J. Ripollés has received fees from Fresenius-Kabi and Edwards Lifesciences, and has been sponsored by Deltex Medical and Braun to attend conferences; Dr. Calvo and J.C. Lau have no conflicts of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:14 [ 0 => array:3 [ "identificador" => "xres594492" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec609432" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres594493" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec609431" "titulo" => "Palabras clave" ] 4 => array:3 [ "identificador" => "sec0005" "titulo" => "Introduction" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Perioperative fluid management" ] 1 => array:3 [ "identificador" => "sec0015" "titulo" => "Scope and objectives" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Rationale and objectives" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Healthcare region" ] ] ] ] ] 5 => array:3 [ "identificador" => "sec0030" "titulo" => "Methodology" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Formation of the working group" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Clinical questions" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "Literature search" ] 3 => array:2 [ "identificador" => "sec0050" "titulo" => "Study selection and evaluation of evidence" ] 4 => array:2 [ "identificador" => "sec0055" "titulo" => "Formulation of recommendations" ] ] ] 6 => array:2 [ "identificador" => "sec0060" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0065" "titulo" => "Discussion and recommendations" ] 8 => array:2 [ "identificador" => "sec0070" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0075" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0080" "titulo" => "CPG working group" ] 11 => array:2 [ "identificador" => "sec0085" "titulo" => "Conflict of interests" ] 12 => array:2 [ "identificador" => "xack199991" "titulo" => "Acknowledgements" ] 13 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-06-08" "fechaAceptado" => "2015-06-26" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec609432" "palabras" => array:5 [ 0 => "Fluid therapy" 1 => "Perioperative period" 2 => "Colloids" 3 => "Clinical practice guide" 4 => "Surgery" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec609431" "palabras" => array:5 [ 0 => "Fluidoterapia" 1 => "Periodo perioperatorio" 2 => "Coloides" 3 => "Guía de práctica clínica" 4 => "Cirugía" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "The present clinical practice guide responds to the clinical questions about security in the choice of fluid (crystalloid, colloid or hydroxyethyl starch 130) in patients who require volume replacement during perioperative period of non-cardiac surgeries. From the evidence summary, recommendations were made following the GRADE methodology. In this population fluid therapy based on crystalloids is suggested (weak recommendation, low quality evidence). In the events where volume replacement is not reached with crystalloids, the use of synthetic colloids (hydroxyethyl starch 130 or modified fluid gelatin) is suggested instead of 5% albumin (weak recommendation, low quality evidence). The choice and dosage of the colloid should be based in the product characteristics, patient comorbidity and anesthesiologist's experience." ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "Esta Guía de Práctica Clínica responde a preguntas clínicas sobre seguridad en la elección de fluido (cristaloide, coloide o Hidroxietilalmidón 130) en pacientes que precisan restauración volémica en el periodo perioperatorio de cirugía no cardiaca. A partir del resumen de la evidencia, se elaboraron las recomendaciones siguiendo la metodología GRADE. En esta población se sugiere la fluidoterapia basada en la administración de cristaloides, (recomendación débil, calidad de la evidencia baja). En las situaciones en las que la restauración volémica no se alcance sólo con cristaloides, se sugiere utilizar coloides sintéticos (Hidroxietilalmidón 130 o gelatina fluida modificada) en lugar de Albúmina 5% (recomendación débil, calidad de la evidencia baja). La elección y dosificación de coloide deberán basarse en las características del producto, comorbilidad del paciente y experiencia del anestesiólogo." ] ] "NotaPie" => array:3 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Basora M, Colomina MJ, Moral V, Asuero de Lis MS, Boix E, Jover JL, et al. Guía de práctica clínica para la elección del fluido de restauración volémica perioperatoria en los pacientes adultos intervenidos de cirugía no cardiaca. Rev Esp Anestesiol Reanim. 2016;63:29–47." ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "This article is part of the Anaesthesiology and Resuscitation Continuing Medical Education Program. An evaluation of the questions on this article can be made through the Internet by accessing the Education Section of the following web page: www.elsevier.es/redar" ] 2 => array:1 [ "nota" => "GUÍA DE PRÁCTICA CLÍNICA. Promotor: SEDAR Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Sección de Hemostasia, Medicina Transfusional y Fluidoterapia de la SEDAR." ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0095" ] ] ] ] "multimedia" => array:16 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1540 "Ancho" => 2677 "Tamanyo" => 183432 ] ] "descripcion" => array:1 [ "en" => "Flowchart." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3580 "Ancho" => 2885 "Tamanyo" => 511448 ] ] "descripcion" => array:1 [ "en" => "Volume replacement algorithm in non-cardiac surgery." ] ] 2 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Clinical situation \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Indication \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Recommended fluid \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Resuscitation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Urgent administration of fluids to restore circulation to vital organs after bleeding, loss of plasma, excessive loss of fluids and electrolytes (usually through the digestive tract) or internal losses (redistribution secondary to sepsis) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Crystalloid or colloid \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Routine maintenance \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Administration of IV fluids in patients who cannot take oral or enteral fluids. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Crystalloids \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Volume replacement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Correct fluid and/or electrolyte deficit due to urinary or gastrointestinal losses, or elevated insensible losses due to fever or burns. Some GI or kidney fluid losses can be high in sodium, chloride and water content. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Crystalloids \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Redistribution \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Usually found in septic or critical patients, or following major surgery or in patients with significant comorbidities. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Crystalloids \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Reassess indications \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Reassess fluid status daily according to the clinical condition of the patient and their fluid and/or electrolyte needs. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Crystalloids \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab972124.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Indications for fluid management according to clinical situation<a class="elsevierStyleCrossRef" href="#bib0420">5</a>" ] ] 3 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Na+mmol/l \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cl−mmol/l \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">K+mmol/l \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Ca++mmol/l \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mg++mmol/l \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Buffer/Bicarbonatemmol/l \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Osm \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">pH \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Price<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> (€) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Plasma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">135–141 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">95–105 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.5–4.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.2–2.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23–27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">289 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">0.9% Saline \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">154 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">154 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">308 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.30–1.90 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ringer (lactate/acetate) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">130 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">109 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28 Lactate/acetate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">273 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.09–1.15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Balance, calcium-free solution (Plasmalyte®) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">140 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27 Acetate23 Gluconate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">295 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Balance solution with calcium (Isofundin®) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">145 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">127 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24 Acetate5 Malate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">309 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.1–5.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.31 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab972123.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Recommended retail price. Catálogo 2014 Medicamentos. Madrid: Consejo General de Colegios Oficiales de Farmacéuticos, 2014. ISBN13: 978-84-87276-82-8." ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of the principle crystalloids used." ] ] 4 => array:7 [ "identificador" => "tbl0025" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Molecule \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Origin \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Molecular weight (daltons) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Amylopectin/amylose content (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">C2/C6 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Initial expansion (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Elimination \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Carrier solution \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Price<a class="elsevierStyleCrossRef" href="#tblfn0010">a</a> (€) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HES 130/0.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Maize \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">130,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">99%/<1% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9/1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Renal clearance and plasma amylase \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ClNa 0.9% and balanced \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HES 130/0.42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Potato \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">130,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">75%/25% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6/1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Renal clearance and plasma amylase \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ClNa 0.9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Succinylated gelatin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bovine collagen \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70–90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Renal clearance and peptidase \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ClNa 0.9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5.26 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Polygelines \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bovine collagen \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70–80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Renal clearance and peptidase \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ClNa 0.9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Not in Spain \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Albumin 5% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Human plasma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">67,000 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Reticuloendothelial system \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ClNa 0.9% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">92.26 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab972127.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "a" "nota" => "Recommended retail price. Catálogo 2014 Medicamentos. Madrid: Consejo General de Colegios Oficiales de Farmacéuticos, 2014. ISBN13: 978-84-87276-82-8." ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of the principle colloids used." ] ] 5 => array:7 [ "identificador" => "tbl0030" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "GRADE summary of findings and quality of evidence tables.High quality: further research is very unlikely to change our confidence in the estimate of effect.Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.Very low quality: we are very uncertain about the estimate." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Study \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Included in systematic review \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Type of surgery \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Crystalloid \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Albumin \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Hydroxyethyl starch \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Gelatin \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Other fluid \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Evans<a class="elsevierStyleCrossRef" href="#bib0695">60</a> 2003 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Perel<a class="elsevierStyleCrossRef" href="#bib0700">61</a> 2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hip replacement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.9% saline (n=14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Albumin 20% (n=13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Modified gelatin 3% (Gelofusine) (n=14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Polygeline (Haemaccel) (n=14) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Feldheiser<a class="elsevierStyleCrossRef" href="#bib0660">53</a> 2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Study retrieved from supplementary search \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Surgical debulking of ovarian cancer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Balanced crystalloid (n=24) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HES 6% 130/0.4 (Voluven) (n=24) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fries<a class="elsevierStyleCrossRef" href="#bib0705">62</a> 2004 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Perel<a class="elsevierStyleCrossRef" href="#bib0700">61</a> 2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Knee arthroplasty \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ringer's lactate (n=20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Modified gelatin 4% (Gelofusine) (n=20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HES 200/0.5 6% (n=20) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hamaji<a class="elsevierStyleCrossRef" href="#bib0650">51</a> 2012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Study retrieved from supplementary search \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hip replacement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ringer's lactate (n=24) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HES 6% 130/0.4 (Voluven) (n=24) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hung<a class="elsevierStyleCrossRef" href="#bib0710">63</a> 2012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Gillies<a class="elsevierStyleCrossRef" href="#bib0715">64</a> 2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Abdominal surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ringer's lactate (n=39) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HES 6% 130/0.4 (Voluven) (n=41) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Innerhofer<a class="elsevierStyleCrossRef" href="#bib0720">65</a> 2002 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Groeneveld<a class="elsevierStyleCrossRef" href="#bib0570">35</a> 2011 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Knee arthroplasty \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ringer's lactate (n=20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Modified gelatin 4%+Ringer's lactate (Gelofusine) (n=20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HES 200/0.5 6% (n=20) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Jin<a class="elsevierStyleCrossRef" href="#bib0725">66</a> 2010 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Van der Linden<a class="elsevierStyleCrossRef" href="#bib0585">38</a> 2013 and Hartog<a class="elsevierStyleCrossRef" href="#bib0545">30</a> 2011 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cancer-related gastrectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ringer's lactate (n=12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HES 6% 130/0.4 (Voluven) (n=12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Modified gelatin 4% (Gelofusine) (n=12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Parker<a class="elsevierStyleCrossRef" href="#bib0730">67</a> 2004 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Saw<a class="elsevierStyleCrossRef" href="#bib0735">68</a> 2012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hip replacement \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.9% saline (n=198) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Modified gelatin 4% (Gelofusine) (n=198) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Rasmussen<a class="elsevierStyleCrossRef" href="#bib0605">42</a> 2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Study retrieved from supplementary search \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Cystectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ringer's lactate (n=16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HES 6% 130/0.4 (Voluven) (n=17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yang<a class="elsevierStyleCrossRef" href="#bib0645">50</a> 2011 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mutter<a class="elsevierStyleCrossRef" href="#bib0740">69</a> 2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hepatectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ringer's lactate (n=25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Albumin 20% (n=30) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HES 130/0.4%, 6% (Voluven) (n=26) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yates<a class="elsevierStyleCrossRef" href="#bib0655">52</a> 2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Study retrieved from supplementary search \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Colectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Balanced crystalloid (n=100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HES 6% 130/0.4 (Voluven) (n=106) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab972117.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of studies used to compare the safety of crystalloids and colloids in volume replacement." ] ] 6 => array:7 [ "identificador" => "tbl0035" "etiqueta" => "Table 5A" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "CI: confidence interval; RR: risk ratio." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Quality assessment \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Patients, n</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Effect</th><th class="td" title="table-head " align="left" valign="top" scope="col">Quality \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Importance of outcome \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Outcome (number of clinical trials:ref) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Albumin \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Crystalloids \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Relative (CI 95%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Absolute<a class="elsevierStyleCrossRef" href="#tblfn0015">*</a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mortality (2):50,60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0/43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0/39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Not assessable \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Not assessable due to no events in at least one group<a class="elsevierStyleCrossRef" href="#tblfn0020">a</a>,<a class="elsevierStyleCrossRef" href="#tblfn0025">b</a>,<a class="elsevierStyleCrossRef" href="#tblfn0030">c</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">⊕Very low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Critical \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kidney failure (defined by author) (1):50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0/30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0/25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Not assessable \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Not assessable due to no events in at least one group<a class="elsevierStyleCrossRef" href="#tblfn0020">a</a>,<a class="elsevierStyleCrossRef" href="#tblfn0025">b</a>,<a class="elsevierStyleCrossRef" href="#tblfn0030">c</a>,<a class="elsevierStyleCrossRef" href="#tblfn0035">d</a>,<a class="elsevierStyleCrossRef" href="#tblfn0040">e</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">⊕Very low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Critical \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Coagulopathy: intraoperative blood loss (ml) (1):50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14ml more (from 119.24 less to 147.24 more)<a class="elsevierStyleCrossRef" href="#tblfn0035">d</a>,<a class="elsevierStyleCrossRef" href="#tblfn0045">f</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">⊕Very low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Critical \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Clinical haemorrhage (1):50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0/30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0/25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Not assessable \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Not assessable due to no events in at least one group<a class="elsevierStyleCrossRef" href="#tblfn0030">c</a>,<a class="elsevierStyleCrossRef" href="#tblfn0035">d</a>,<a class="elsevierStyleCrossRef" href="#tblfn0045">f</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">⊕Very low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Critical \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Venous thrombosis (1):50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9/30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5/25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RR 1.50 (0.58–3.90) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100 cases more per 1000 (from 84 less to 580 more)<a class="elsevierStyleCrossRef" href="#tblfn0025">b</a>,<a class="elsevierStyleCrossRef" href="#tblfn0035">d</a>,<a class="elsevierStyleCrossRef" href="#tblfn0045">f</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">⊕Very low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Important \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Length of ICU stay (days) (1):50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.1 day less (from 0.52 less to 0.32 more)<a class="elsevierStyleCrossRef" href="#tblfn0035">d</a>,<a class="elsevierStyleCrossRef" href="#tblfn0045">f</a>,<a class="elsevierStyleCrossRef" href="#tblfn0050">g</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">⊕⊕Low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Important \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Length of hospital stay (days) (1):50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(from 0.40 less to 0.40 more)<a class="elsevierStyleCrossRef" href="#tblfn0025">b</a>,<a class="elsevierStyleCrossRef" href="#tblfn0035">d</a>,<a class="elsevierStyleCrossRef" href="#tblfn0045">f</a>,<a class="elsevierStyleCrossRef" href="#tblfn0050">g</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">⊕Very low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Important \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab972116.png" ] ] ] "notaPie" => array:8 [ 0 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "*" "nota" => "Assumed risk is based on the median risk for all control group studies. The corresponding risk (with 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (with 95% CI)." ] 1 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "a" "nota" => "Generation of randomisation sequence and allocation unclear." ] 2 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "b" "nota" => "Few events. The 95% confidence interval includes zero." ] 3 => array:3 [ "identificador" => "tblfn0030" "etiqueta" => "c" "nota" => "No events presented. RR not assessable." ] 4 => array:3 [ "identificador" => "tblfn0035" "etiqueta" => "d" "nota" => "Important losses to follow-up." ] 5 => array:3 [ "identificador" => "tblfn0040" "etiqueta" => "e" "nota" => "Only one study with events." ] 6 => array:3 [ "identificador" => "tblfn0045" "etiqueta" => "f" "nota" => "Major heterogeneity I2 75% p=0.003." ] 7 => array:3 [ "identificador" => "tblfn0050" "etiqueta" => "g" "nota" => "The 95% confidence interval includes zero." ] ] ] "descripcion" => array:1 [ "en" => "Summary of findings and quality of evidence: albumin vs crystalloids (question 1)." ] ] 7 => array:7 [ "identificador" => "tbl0040" "etiqueta" => "Table 5B" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "CI: confidence interval; RR: risk ratio." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Quality assessment \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Patients, n</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Effect</th><th class="td" title="table-head " align="left" valign="top" scope="col">Quality \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Importance of outcome \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Outcome (number of clinical trials) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">(HES MP 130) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Crystalloids \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Relative (CI 95%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Absolute<a class="elsevierStyleCrossRef" href="#tblfn0055">*</a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mortality (5):50–53,63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7/221 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2/209 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RR 2.57 (0.7–9.49) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15 more per 1000 (from 3 less to 81 more)<a class="elsevierStyleCrossRef" href="#tblfn0060">a</a>,<a class="elsevierStyleCrossRef" href="#tblfn0065">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">⊕⊕Low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Critical \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kidney failure (defined by author) (4):50–53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5/180 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0/173 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RR 5.79 (0.7–47.67)<a class="elsevierStyleCrossRef" href="#tblfn0060">a</a>,<a class="elsevierStyleCrossRef" href="#tblfn0065">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">⊕Very low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Critical \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">RIFLE at risk or very serious (1):50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0/26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RR 0.32 (0.01–7.53) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27 less per 1000 (from 40 less to 261 more)<a class="elsevierStyleCrossRef" href="#tblfn0060">a</a>,<a class="elsevierStyleCrossRef" href="#tblfn0065">b</a>,<a class="elsevierStyleCrossRef" href="#tblfn0070">c</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">⊕⊕Low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Critical \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Acute pulmonary oedema (1):52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5/106 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2/100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RR 2.36 (0.47–11.88) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27 more per 1000 (from 11 less to 218 more)<a class="elsevierStyleCrossRef" href="#tblfn0065">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">⊕⊕⊕Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Critical \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Coagulopathy: intraoperative blood loss (ml) (3):50,63,66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">76 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33.73ml less (from 180.18 less to 112.73 more)<a class="elsevierStyleCrossRef" href="#tblfn0060">a</a>,<a class="elsevierStyleCrossRef" href="#tblfn0075">d</a>,<a class="elsevierStyleCrossRef" href="#tblfn0080">e</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">⊕Very low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Critical \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Coagulopathy: Blood loss up to 1st POP day (accumulative, ml) (3):42,51,52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">147 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">140 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">329.6ml more (from 69.48 less to 728.67 more)<a class="elsevierStyleCrossRef" href="#tblfn0060">a</a>,<a class="elsevierStyleCrossRef" href="#tblfn0080">e</a>,<a class="elsevierStyleCrossRef" href="#tblfn0085">f</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">⊕Very low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Critical \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Myocardial infarction (1):52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">11/106 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4/100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RR 2.59 (0.85–7.88) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">64 more per 1000 (from 6 less to 275 more)<a class="elsevierStyleCrossRef" href="#tblfn0070">c</a>,<a class="elsevierStyleCrossRef" href="#tblfn0080">e</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">⊕⊕○○Low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Important \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sepsis (1):52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13/106 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8/100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RR 1.53 (0.66–3.54) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">42 more per 1000 (from 27 less to 203 more)<a class="elsevierStyleCrossRef" href="#tblfn0070">c</a>,<a class="elsevierStyleCrossRef" href="#tblfn0080">e</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">⊕⊕Low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Important \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Length of ICU stay (days) (1):50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.1 less (0.51 less to 0.31 more)<a class="elsevierStyleCrossRef" href="#tblfn0060">a</a>,<a class="elsevierStyleCrossRef" href="#tblfn0070">c</a>,<a class="elsevierStyleCrossRef" href="#tblfn0080">e</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">⊕⊕Low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Important \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab972128.png" ] ] ] "notaPie" => array:7 [ 0 => array:3 [ "identificador" => "tblfn0055" "etiqueta" => "*" "nota" => "Estimated risk is based on the median risk for all control group studies. The corresponding risk (with 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (with 95% CI)." ] 1 => array:3 [ "identificador" => "tblfn0060" "etiqueta" => "a" "nota" => "Randomisation sequence unclear, or no randomisation." ] 2 => array:3 [ "identificador" => "tblfn0065" "etiqueta" => "b" "nota" => "Few events. The 95% confidence interval includes zero." ] 3 => array:3 [ "identificador" => "tblfn0070" "etiqueta" => "c" "nota" => "Only one study." ] 4 => array:3 [ "identificador" => "tblfn0075" "etiqueta" => "d" "nota" => "Major heterogeneity I2 77% p=0.01." ] 5 => array:3 [ "identificador" => "tblfn0080" "etiqueta" => "e" "nota" => "The 95% confidence interval includes zero." ] 6 => array:3 [ "identificador" => "tblfn0085" "etiqueta" => "f" "nota" => "Major heterogeneity I2 79% p=0.009." ] ] ] "descripcion" => array:1 [ "en" => "Summary of findings and quality of evidence: hydroxyethyl starch (HES) MP 130 vs crystalloids (question 1)." ] ] 8 => array:7 [ "identificador" => "tbl0045" "etiqueta" => "Table 5C" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "CI: confidence interval; RR: risk ratio." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Quality assessment \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Patients, n</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Effect</th><th class="td" title="table-head " align="left" valign="top" scope="col">Quality \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Importance of outcome \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Number of clinical trials \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Modified gelatin \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Crystalloids \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Relative (CI 95%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Absolute<a class="elsevierStyleCrossRef" href="#tblfn0090">*</a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mortality (3):60.62,67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19/232 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9/232 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RR 2.11 (0.98 to 4.55) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">43 more per 1000 (from 1 less to 138 more)<a class="elsevierStyleCrossRef" href="#tblfn0095">a</a>,<a class="elsevierStyleCrossRef" href="#tblfn0100">b</a>,<a class="elsevierStyleCrossRef" href="#tblfn0105">c</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">⊕⊕Low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Critical \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Coagulopathy: intraoperative blood loss (ml) (2):65–66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">32 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.33ml more (from 50.14 less to 50.8 more)<a class="elsevierStyleCrossRef" href="#tblfn0095">a</a>,<a class="elsevierStyleCrossRef" href="#tblfn0105">c</a>,<a class="elsevierStyleCrossRef" href="#tblfn0110">d</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">⊕Very low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Critical \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Coagulopathy: blood loss up to 1st day POP (ml) (1):62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">34ml more (from 120.88 less to 188.88 more)<a class="elsevierStyleCrossRef" href="#tblfn0095">a</a>,<a class="elsevierStyleCrossRef" href="#tblfn0100">b</a>,<a class="elsevierStyleCrossRef" href="#tblfn0105">c</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">⊕Very low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Critical \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Heart failure (1):67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13/198 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8/198 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RR 1.62 (0.69–3.83) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25 more per 1000 (from 13 less to 114 more)<a class="elsevierStyleCrossRef" href="#tblfn0105">c</a>,<a class="elsevierStyleCrossRef" href="#tblfn0110">d</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">⊕⊕Low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Important \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Myocardial infarction (1):67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/198 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0/198 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RR 3 (0.12–73.2)<a class="elsevierStyleCrossRef" href="#tblfn0105">c</a>,<a class="elsevierStyleCrossRef" href="#tblfn0110">d</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">⊕⊕○○Low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Important \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Venous thrombosis (1):67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5/198 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5/198 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RR 1 (0.29–3.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 less per 1000 (from 18 less to 61 more)<a class="elsevierStyleCrossRef" href="#tblfn0105">c</a>,<a class="elsevierStyleCrossRef" href="#tblfn0110">d</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">⊕⊕⊕Moderate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Important \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab972118.png" ] ] ] "notaPie" => array:5 [ 0 => array:3 [ "identificador" => "tblfn0090" "etiqueta" => "*" "nota" => "Estimated risk is based on the median risk for all control group studies. The corresponding risk (with 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (with 95% CI)." ] 1 => array:3 [ "identificador" => "tblfn0095" "etiqueta" => "a" "nota" => "Generation of randomisation sequence and allocation unclear. Some non-blinded studies." ] 2 => array:3 [ "identificador" => "tblfn0100" "etiqueta" => "b" "nota" => "Only one study with events." ] 3 => array:3 [ "identificador" => "tblfn0105" "etiqueta" => "c" "nota" => "The 95% CI includes zero." ] 4 => array:3 [ "identificador" => "tblfn0110" "etiqueta" => "d" "nota" => "Only one study." ] ] ] "descripcion" => array:1 [ "en" => "Summary of findings and quality of evidence: modified gelatin vs crystalloids (question 1)." ] ] 9 => array:7 [ "identificador" => "tbl0050" "etiqueta" => "Table 6" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Study \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Included in systematic review \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Type of surgery \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Albumin \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Hydroxyethyl starch \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Gelatin \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Other fluid \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Other fluid \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Godet<a class="elsevierStyleCrossRef" href="#bib0665">54</a> 2008 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bunn<a class="elsevierStyleCrossRef" href="#bib0560">33</a> 2012, Mutter<a class="elsevierStyleCrossRef" href="#bib0740">69</a> 2013 and Toomtong<a class="elsevierStyleCrossRef" href="#bib0745">70</a> 2010 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Vascular surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HES 6% 130/0.4 (Voluven) (n=32) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Modified gelatin 3% (Plasmion) (n=33) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Jin<a class="elsevierStyleCrossRef" href="#bib0725">66</a> 2010 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bunn<a class="elsevierStyleCrossRef" href="#bib0560">33</a> 2012, Hartog<a class="elsevierStyleCrossRef" href="#bib0545">30</a> 2011 and Van der Linden<a class="elsevierStyleCrossRef" href="#bib0585">38</a> 2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Gastrectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HES 6% 130/0.4 (Voluven) (n=12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Modified gelatin 4% (Gelofusine) (n=12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ringer's lactate (n=12) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kim<a class="elsevierStyleCrossRef" href="#bib0750">71</a> 2009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Van der Linden<a class="elsevierStyleCrossRef" href="#bib0585">38</a> 2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Major non-cardiac surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Albumin 20% (n=19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HES 6% 130/0.4 (Voluven) (n=41) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Liang<a class="elsevierStyleCrossRef" href="#bib0755">72</a> 2006 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hartog<a class="elsevierStyleCrossRef" href="#bib0545">30</a> 2011 and Saw<a class="elsevierStyleCrossRef" href="#bib0735">68</a> 2012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Large bowel resection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HES 6% 130/0.4 (Voluven) (n=20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Gelatin (succinyl gelatin) 4% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ringer's lactate (n=20) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mahmood<a class="elsevierStyleCrossRef" href="#bib0670">55</a> 2007 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bunn<a class="elsevierStyleCrossRef" href="#bib0560">33</a> 2012 and Toomtong<a class="elsevierStyleCrossRef" href="#bib0745">70</a> 2010, Mutter<a class="elsevierStyleCrossRef" href="#bib0740">69</a> 2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Aortic surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HES 6% 130/0.4 (Voluven) (n=21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Gelatin 4% (Gelofusine) (n=20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HES 200/0.62 (n=21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mittermayr<a class="elsevierStyleCrossRef" href="#bib0760">73</a> 2007 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bunn<a class="elsevierStyleCrossRef" href="#bib0560">33</a> 2012, Groeneveld<a class="elsevierStyleCrossRef" href="#bib0570">35</a> 2011 and Hartog<a class="elsevierStyleCrossRef" href="#bib0545">30</a> 2011 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Orthopaedic surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HES 6% 130/0.4 (Voluven) (n=19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Gelatin 4% (Gelofusine) (n=21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ringer's lactate (n=21) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mukhtar<a class="elsevierStyleCrossRef" href="#bib0675">56</a> 2009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bunn<a class="elsevierStyleCrossRef" href="#bib0560">33</a> 2012 and Mutter<a class="elsevierStyleCrossRef" href="#bib0740">69</a> 2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Liver transplant recipients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Albumin 5% (n=20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HES 6% 130/0.4 (Voluven) (n=20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Staikou<a class="elsevierStyleCrossRef" href="#bib0765">74</a> 2012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Study retrieved from supplementary search \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Abdominal surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HES 6% 130/0.4 (Voluven) (n=25) vs HES 6% 130/0.42 (n=24) (Venofundin) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Topcu<a class="elsevierStyleCrossRef" href="#bib0770">75</a> 2012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Study retrieved from supplementary search \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Major orthopaedic surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HES 6% 130/0.4 (Voluven) (n=25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Gelatin 4% (succinyl gelatin) (n=25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ringer's lactate (n=25) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Volta<a class="elsevierStyleCrossRef" href="#bib0775">76</a> 2007 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bunn<a class="elsevierStyleCrossRef" href="#bib0560">33</a> 2012 and Hartog<a class="elsevierStyleCrossRef" href="#bib0545">30</a> 2011 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Major cancer-related abdominal surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HES 6% 130/0.4 (Voluven) (n=12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Polygeline 4% (n=12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ringer's lactate (n=12) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Wu<a class="elsevierStyleCrossRef" href="#bib0680">57</a> 2010 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Gattas<a class="elsevierStyleCrossRef" href="#bib0780">77</a> 2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Kidney transplant \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HES 6% 130/0.4 (Voluven) (n=38) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Gelatin 4% (succinyl gelatin) (n=39) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yangx 2011 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Bunn<a class="elsevierStyleCrossRef" href="#bib0560">33</a> 2012 and Mutter<a class="elsevierStyleCrossRef" href="#bib0740">69</a> 2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hepatectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Albumin 20% (n=30) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HES 6% 130/0.4 (Voluven) (n=26) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Ringer's lactate (n=25) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yassen et al.<a class="elsevierStyleCrossRef" href="#bib0685">58</a> 2011 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mutter<a class="elsevierStyleCrossRef" href="#bib0740">69</a> 2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Liver transplant recipients \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Albumin 4% (n=15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HES 6% 130/0.4 (Voluven) (n=30) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Zdolsek<a class="elsevierStyleCrossRef" href="#bib0785">78</a> 2011 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Gattas<a class="elsevierStyleCrossRef" href="#bib0780">77</a> 2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Orthopaedic surgery \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">HES 6% 130/0.4 (Voluven) vs HES 6% 130/0.4 (Venofundin) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Dextran 70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab972122.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of studies used to compare the safety of crystalloids and colloids in volume replacement." ] ] 10 => array:7 [ "identificador" => "tbl0055" "etiqueta" => "Table 7A" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "CI: confidence interval; RR: risk ratio." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Quality assessment \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Patients, n</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Effect</th><th class="td" title="table-head " align="left" valign="top" scope="col">Quality \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Importance of outcome \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Number of clinical trials \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Albumin \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HES \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Relative (CI 95%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Absolute<a class="elsevierStyleCrossRef" href="#tblfn0115">*</a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mortality (up to hospital discharge) (2):50–56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RR 1 (0.07–14.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 less per 1000 (from 20 less to 302 more)1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">⊕⊕Low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Critical \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Impairment of kidney function (RIFLE risk) (2):50,58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2/45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2/56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RR 2 (0.31–12.84) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">36 more per 1000 (from 25 less to 423 more)<a class="elsevierStyleCrossRef" href="#tblfn0120">a</a>,<a class="elsevierStyleCrossRef" href="#tblfn0125">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">⊕Very low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Critical \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Renal replacement therapy (1):56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RR 1 (0.07–14.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 less per 1000 (from 47 less to 695 more)<a class="elsevierStyleCrossRef" href="#tblfn0120">a</a>,<a class="elsevierStyleCrossRef" href="#tblfn0130">c</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">⊕Very low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Critical \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Intraoperative blood loss (1):50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">47 more (from 92.75 less to 186.75 more)<a class="elsevierStyleCrossRef" href="#tblfn0120">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">⊕⊕Low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Critical \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Blood loss at 24hours POP (ml) (1):71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">203 more (from 7.97 to 398.03 more)<a class="elsevierStyleCrossRef" href="#tblfn0130">c</a>,<a class="elsevierStyleCrossRef" href="#tblfn0135">d</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">⊕⊕Low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Critical \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Blood loss at 72hours POP (ml) (1):71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">228 more (from 49.08 less to 505.08 more)<a class="elsevierStyleCrossRef" href="#tblfn0120">a</a>,<a class="elsevierStyleCrossRef" href="#tblfn0130">c</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">⊕Very low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Critical \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Time on ventilation (days) (2):56.71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">61 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.18 less (from 1.42 less to 1.06 more)<a class="elsevierStyleCrossRef" href="#tblfn0125">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">⊕⊕Low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Critical \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab972125.png" ] ] ] "notaPie" => array:5 [ 0 => array:3 [ "identificador" => "tblfn0115" "etiqueta" => "*" "nota" => "Assumed risk is based on the median risk for all control group studies. The corresponding risk (with 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (with 95% CI)." ] 1 => array:3 [ "identificador" => "tblfn0120" "etiqueta" => "a" "nota" => "Very wide CI that includes zero." ] 2 => array:3 [ "identificador" => "tblfn0125" "etiqueta" => "b" "nota" => "Incomplete follow-up data." ] 3 => array:3 [ "identificador" => "tblfn0130" "etiqueta" => "c" "nota" => "Blinding unclear." ] 4 => array:3 [ "identificador" => "tblfn0135" "etiqueta" => "d" "nota" => "Very wide CI." ] ] ] "descripcion" => array:1 [ "en" => "Summary of findings and quality of evidence table: albumin vs hydroxyethyl starch (HES) (question 2)." ] ] 11 => array:7 [ "identificador" => "tbl0060" "etiqueta" => "Table 7B" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "CI: confidence interval; RR: risk ratio." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Quality assessment \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">No. patients</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Effect</th><th class="td" title="table-head " align="left" valign="top" scope="col">Quality \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Importance of outcome \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Number of clinical trials \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Modified gelatin \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HES \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Relative (CI 95%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Absolute<a class="elsevierStyleCrossRef" href="#tblfn0140">*</a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mortaligy (at 28 or 30 days) (2):54,55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8/54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3/54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RR 2.39 (0.37–15.28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">77 more per 1000 (from 35 less to 793 more)<a class="elsevierStyleCrossRef" href="#tblfn0145">a</a>,<a class="elsevierStyleCrossRef" href="#tblfn0150">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">⊕⊕Low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Critical \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Renal replacement therapy (1):55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1/21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RR 1 (0.07–14.95) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0 less per 1000 (from 44 less to 664 more)<a class="elsevierStyleCrossRef" href="#tblfn0145">a</a>,<a class="elsevierStyleCrossRef" href="#tblfn0155">c</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">⊕⊕Low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Critical \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Blood loss at 24hours POP (ml) (4):55,66,72,73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">21.47 less (from 68.35 less to 25.41 more)<a class="elsevierStyleCrossRef" href="#tblfn0145">a</a>,<a class="elsevierStyleCrossRef" href="#tblfn0155">c</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">⊕⊕Low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Critical \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab972126.png" ] ] ] "notaPie" => array:4 [ 0 => array:3 [ "identificador" => "tblfn0140" "etiqueta" => "*" "nota" => "Assumed risk is based on the median risk for all control group studies. The corresponding risk (with 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (with 95% CI)." ] 1 => array:3 [ "identificador" => "tblfn0145" "etiqueta" => "a" "nota" => "Very wide CI that includes zero." ] 2 => array:3 [ "identificador" => "tblfn0150" "etiqueta" => "b" "nota" => "Small sample size, few events." ] 3 => array:3 [ "identificador" => "tblfn0155" "etiqueta" => "c" "nota" => "Blinding unclear." ] ] ] "descripcion" => array:1 [ "en" => "Summary of findings and quality of evidence: modified gelatin vs hydroxyethyl starch (HES) (question 2)." ] ] 12 => array:7 [ "identificador" => "tbl0065" "etiqueta" => "Table 7C" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "CI: confidence interval." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Quality assessment \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Patients</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Effect</th><th class="td" title="table-head " align="left" valign="top" scope="col">Quality \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Importance of outcome \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Number of clinical trials \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HES 130/0.42 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HES 130/0.4 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Relative (CI 95%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Absolute<a class="elsevierStyleCrossRef" href="#tblfn0160">*</a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Intraoperative blood loss (1):78 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">28 more (from 188.99 less to 244.99 more)<a class="elsevierStyleCrossRef" href="#tblfn0165">a</a>,<a class="elsevierStyleCrossRef" href="#tblfn0170">b</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">⊕Very low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Critical \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab972121.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0160" "etiqueta" => "*" "nota" => "Assumed risk is based on the median risk for all control group studies. The corresponding risk (with 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (with 95% CI)." ] 1 => array:3 [ "identificador" => "tblfn0165" "etiqueta" => "a" "nota" => "Blinding unclear." ] 2 => array:3 [ "identificador" => "tblfn0170" "etiqueta" => "b" "nota" => "Very wide CI that includes zero." ] ] ] "descripcion" => array:1 [ "en" => "Summary of findings and quality of evidence table: comparison 3: HES 130/0.42 vs HES 130/0.4 (question 2)." ] ] 13 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.docx" "ficheroTamanyo" => 111014 ] ] 14 => array:5 [ "identificador" => "tbl0005" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => false "mostrarDisplay" => true "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Question 1. Which type of fluid (colloids or crystalloids) has the best safety profile for perioperative volume replacement in non-cardiac surgery?</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Recommendation</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">In patients undergoing non-cardiac surgery, fluid management with crystalloids are recommended over colloids. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Weak recommendation in favour (Low quality of evidence) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Justification</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Available studies have not shown any difference between the use of colloids and crystalloids in terms of critical outcomes such as mortality, impairment of kidney function and coagulopathy, among others. The quality of the evidence is low, and colloids are more expensive than crystalloids. For these reasons, a weak recommendation is given in favour of crystalloids.</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Research recommendations</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Clinical trials of a higher methodological quality with more appropriate sample sizes are needed to investigate critical outcomes. Studies evaluating the cost-effectiveness of treatment strategies are also needed.</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab972120.png" ] ] ] ] ] 15 => array:5 [ "identificador" => "tbl0010" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => false "mostrarDisplay" => true "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Question 2. Which colloid solution has the best safety profile for perioperative volume replacement in non-cardiac surgery?</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Recommendation</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hydroxyethyl starch (HES 130/0.42 or HES 130/0.4) or modified gelatins are recommended over albumin in non-cardiac surgery patients requiring volume replacement. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Weak recommendation in favour (Low quality of evidence) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Justification</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Available studies have not shown any difference between different types of colloids in terms of critical outcomes such as mortality, impairment of kidney function and coagulopathy, among others. The quality of the evidence is low, and albumin is significantly more expensive than other colloids. For these reasons, a weak recommendation is given in favour of hydroxyethyl starch or modified gelatin.</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Research recommendations</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Clinical trials of a higher methodological quality with more appropriate sample sizes are needed to investigate critical outcomes. Studies evaluating the cost-effectiveness of treatment strategies are also needed.</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab972119.png" ] ] ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:79 [ 0 => array:3 [ "identificador" => "bib0400" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Postoperative fluid overload: not a benign problem" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "1990" "volumen" => "18" "paginaInicial" => "728" "paginaFinal" => "733" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0405" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A rational approach to perioperative fluid management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ …5] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ALN.0b013e3181863117" "Revista" => array:6 [ "tituloSerie" => "Anesthesiology" "fecha" => "2008" "volumen" => "109" "paginaInicial" => "723" "paginaFinal" => "740" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0410" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "British Consensus Guidelines on Intravenous Fluid Therapy for Adult Surgical Patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:2 [ "fecha" => "2011" "editorial" => "GIFTASUP" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0415" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guidelines for perioperative haemodynamic optimization" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ …6] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.annfar.2013.09.010" "Revista" => array:6 [ "tituloSerie" => "Ann Fr Anesth Reanim" "fecha" => "2013" "volumen" => "32" "paginaInicial" => "e151" "paginaFinal" => "e158" "link" => array:1 [ 0 => array:2 [ …2] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0420" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "National Institute for Health and Care Excellence. 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Special article

Clinical practice guide for the choice of perioperative volume-restoring fluid in adult patients undergoing non-cardiac surgery

Guía de práctica clínica para la elección del fluido de restauración volémica perioperatoria en los pacientes adultos intervenidos de cirugía no cardiaca

M. Basoraa,

Corresponding author

mbasora@clinic.ub.es

Corresponding author.

, M.J. Colominab, V. Moralc, M.S. Asuero de Lisd, E. Boixe, J.L. Joverf, J.V. Llaug, M.P. Rodrigoh, J. Ripollési, J.M. Calvo Vecinoj

a Anestesiología y Reanimación, Hospital Clínic, Barcelona, Spain

b Anestesiología y Reanimación, Hospital Universitario Vall d’Hebron, Barcelona, Spain

c Anestesiología y Reanimación, Hospital Sant Pau, Barcelona, Spain

d Anestesiología y Reanimación, Hospital Universitario Ramón y Cajal, Madrid, Spain

e Anestesiología y Reanimación, Hospital Universitario del Vinalopó, Elche, Alicante, Spain

f Anestesiología y Reanimación, Hospital Verge dels Lliris, Alcoi, Alicante, Spain

g Anestesiología y Reanimación, Hospital Clínico Universitario, Valencia, Spain

h Anestesiología y Reanimación, Hospital de Basurto, Bilbao, Spain

i Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Madrid, Spain

j Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Universidad Complutense, Madrid, Spain

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        "titulo" => "Gu&#237;a de pr&#225;ctica cl&#237;nica para la elecci&#243;n del fluido de restauraci&#243;n vol&#233;mica perioperatoria en los pacientes adultos intervenidos de cirug&#237;a no cardiaca"
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Volume replacement algorithm in non-cardiac surgery&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Fluid management has undergone major changes in clinical practice in recent years&#46; The criteria for volume replacement described in classic anaesthesiology textbooks were based on weak scientific evidence&#46; Since then&#44; perioperative fluid management has undergone a paradigm shift influenced by factors such the higher mortality rate associated with perioperative fluid overload&#44;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">1</span></a> evidence proving the inexistence of a non-anatomical third space&#44; and the need to preserve the vascular endothelium and glycocalyx&#46;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">2</span></a> Based on this improved scientific understanding&#44; major changes in fluid administration criteria were proposed and accepted at the start of this century&#44; and this led to the adoption of a generally more restrictive approach to fluid management&#46;<a class="elsevierStyleCrossRefs" href="#bib0410"><span class="elsevierStyleSup">3&#8211;5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Technological developments&#44; meanwhile&#44; in the form of less invasive monitoring systems capable of measuring dynamic changes in volaemia and predicting the response to fluid administration&#44; have given clinicians a far more sophisticated and simple method of guiding intravenous fluid management&#46;<a class="elsevierStyleCrossRefs" href="#bib0425"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In the context of this improved understanding of fluid management in clinical practice&#44; situations have arisen that have scandalised scientific societies and created confusion among clinicians&#46; First&#44; most of the literature relating to fluid management was found to be fraudulent&#44; and what little scientific evidence remained after journals retracted the articles published by Boldt had to be re-evaluated&#46;<a class="elsevierStyleCrossRefs" href="#bib0435"><span class="elsevierStyleSup">8&#44;9</span></a> Furthermore&#44; some heterogeneous studies published in recent years have questioned the safety of colloid administration in critical patients&#46; This prompted the European Medicines Agency&#39;s Pharmacovigilance Risk Assessment Committee &#40;PRAC&#41;<a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">10</span></a> to recommend suspending the marketing authorisation of medicines containing hydroxyethyl starch &#40;HES&#41; on the grounds that the benefits no longer outweighed the risks&#46; A subsequent evaluation revoked the suspension and the product was authorised subject to strict conditions of use&#44; which excluded critically ill patients&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Following these upheavals&#44; we deemed it necessary to evaluate the existing scientific evidence relating to the safety of perioperative fluid management strategies and divulge our findings in these clinical practices guidelines &#40;CPG&#41;&#46; We have developed other guidelines for the intraoperative haemodynamic optimisation of adult patients undergoing non-cardiac surgery&#44; and for this reason fluid management in this context is not discussed in these GPGs&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In drawing up these guidelines&#44; we have excluded all articles published prior to 2000 for two reasons&#58; First&#44; we consider that the new century has ushered in a change in clinical practice&#44; mainly following publication of the study by Rivers et al&#46;<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">11</span></a> in 2001&#44; showing that early&#44; goal-directed fluid management improves evolution in patients with severe sepsis&#46; This study in many ways marks the turning point in fluid management&#44; and was followed by the implementation of laparoscopic and fast track surgery&#44; both of which have considerably reduced the need for perioperative fluid administration&#46;<a class="elsevierStyleCrossRefs" href="#bib0455"><span class="elsevierStyleSup">12&#44;13</span></a> Secondly&#44; most of the studies published prior to this date discuss products that have been withdrawn from the market&#44; or that have been largely sidelined&#46; Furthermore&#44; they obviously do not include products released in recent years&#46;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">14</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In these guidelines&#44; therefore&#44; we will restrict our analysis to articles that discuss the crystalloids and&#47;or colloids most widely used in Spain today&#46;<a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">15</span></a> We have included crystalloids&#44; albumin&#44; gelatins and third-generation HES solutions&#44; and have specifically excluded both dextrans and second-generation HES&#46; Studies in cardiac surgery and critically ill patients have also been excluded from our analysis&#44; insofar as fluid management strategies differ considerably in these contexts&#44; and exceed the scope of this CPG&#46;</p><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Perioperative fluid management</span><p id="par0035" class="elsevierStylePara elsevierViewall">The aim of fluid management is to maintain the body&#39;s hydration status and tissue perfusion at optimum levels and normalise electrolyte balance by promptly replacing fluids&#44; thus preventing adverse effects&#44; and ultimately&#44; balancing tissue-level oxygen supply and demand&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">As with any drugs&#44; indications for fluid and dose regimens must be goal-directed&#46; An understanding of the patient&#39;s clinical situation will guide the clinician in choosing the correct type of fluid and the manner of administration&#46;<a class="elsevierStyleCrossRefs" href="#bib0405"><span class="elsevierStyleSup">2&#44;16&#44;17</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Indications for fluid management in surgical patients are based on the &#8220;5Rs&#8221; of the NICE clinical guidelines &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Surgical patients may need fluids to correct various clinical situation&#58; to restore volume levels due to blood loss&#59; to maintain fluid levels following surgery&#59; to replace gastrointestinal or urinary tract losses or significant insensible losses due to fever or burns&#59;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">5</span></a> fluid redistribution may cause tissue oedema due to fluid and sodium overload&#44; and fluid may become trapped in the gastrointestinal tract or in the thoracic and&#47;or peritoneal cavity&#46;<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">18</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Surgical patients can present haemodynamic changes secondary to anaesthesia&#44; such as vasoparalysis and vasodilation in response to neuraxial blockade&#46;<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">19</span></a> Surgery-induced haemodynamic changes can also occur as a result of patient positioning<a class="elsevierStyleCrossRef" href="#bib0495"><span class="elsevierStyleSup">20</span></a> or pressure applied to body cavities&#44; such as the pneumoperitoneum induced to facilitate laparoscopic surgery&#46; All these can lead to volume deficit&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">A wide range of fluids are available for use in clinical practice&#44; and the choice of one or another is determined by clinical preference&#44; institutional protocols&#44; availability&#44; cost&#44; and marketing strategies&#46;<a class="elsevierStyleCrossRefs" href="#bib0410"><span class="elsevierStyleSup">3&#44;15&#44;21&#44;22</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Evidence for the choice of fluid is scarce&#44; and of low quality&#46; Besides&#44; the secondary effects associated with fluid management will not only depend on the fluid chosen&#44; but also on the clinical situation of the patient&#44; and this must be taken into account when considering the precautions and contraindications for a particular fluid&#46;<a class="elsevierStyleCrossRefs" href="#bib0465"><span class="elsevierStyleSup">14&#44;23</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Fluid replacement solutions are typically classified into two groups according to their composition and physical and chemical properties&#58; crystalloids and colloids&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Crystalloids are solutions of ions that are freely permeate semipermeable membranes&#44; but contain concentrations of sodium and chloride that determine the tonicity of the fluid &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 2</a>&#41;&#46; Crystalloids can contain anions&#8211;acetate&#44; malate&#44; lactate&#44; gluconate&#44; citrate&#8211;which are converted into bicarbonate&#46; Administration of crystalloids does not affect the acid&#8211;base balance&#46; Depending on their relative tonicity in relation to plasma&#44; crystalloids can be classified as hypotonic&#44; isotonic and hypertonic&#46; They are also grouped into balanced and unbalanced solutions depending on their properties&#44; physical and chemical composition&#44; and similarity to plasma&#46; Balanced crystalloids are similar to plasma in terms of osmolarity and composition of their main electrolytes&#44; and are recommended due to their small sodium and chloride contents compared to saline solutions&#46; NaCl &#40;0&#46;9&#37;&#41; can be useful in gastrointestinal losses&#59; however&#44; in many cases the fluid lost contains potassium magnesium and calcium&#44; and in this respect balanced crystalloids are preferable to NaCl&#46; This is why balanced solutions are gaining ground in fluid management strategies for surgical patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0515"><span class="elsevierStyleSup">24&#8211;26</span></a></p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Colloids are suspensions of molecules within a carrier solution that are relatively incapable of crossing the healthy semipermeable capillary membrane&#44; and therefore circulate exclusively in the intravascular compartment&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Medicinal colloids are classified as natural &#40;albumin&#41; and semi-synthetic &#40;gelatins and HES&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">The volumetric effect of an isotonic colloid will be determined by the volumetric status of the patient&#46; Therefore&#44; in a hypovolaemic patient&#44; it will expand volume by 100&#37;&#44; while in a normo- or hypervolaemic patient&#44; its expansion capacity will not exceed 40&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">14</span></a> Albumin is a protein synthesised in the liver&#44; and makes up over 50&#37; of plasmic protein&#46; It is essential for the transport of endogenous and exogenous substances&#46; It has a role as a weak acid &#40;to maintain the acid-base balance&#41;&#44; and has antioxidant and antiinflammatory properties&#46;<a class="elsevierStyleCrossRef" href="#bib0530"><span class="elsevierStyleSup">27</span></a> For medicinal purposes&#44; it is extracted from blood and is processed to prevent transmission of pathogenic viruses&#46; It is sold in a variety of solutions&#44; each with a different concentration&#46; A 5&#37; albumin solution is the most widely used in volume replacement&#44; while 20&#37; and 25&#37; solutions are usually used to treat hypoproteinaemia&#46; Following IV administration&#44; it has an intravascular half-life of around 16<span class="elsevierStyleHsp" style=""></span>h or even less in patients with altered capillary permeability&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">According to the 2103 revision of the Spanish version of the summary of product characteristics&#44;<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">28</span></a> the therapeutic indications of albumin include the restoration and maintenance of circulating blood volume where volume deficiency has been demonstrated&#44; and use of a colloid is inappropriate&#46; The choice of albumin rather than an artificial colloid will depend on the clinical situation of the individual patient&#46;<a class="elsevierStyleCrossRefs" href="#bib0540"><span class="elsevierStyleSup">29&#44;30</span></a> Albumin is authorised for use in patients on dialysis and in premature infants&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Gelatins are polypeptides obtained from bovine collagen&#46; The transformation of insoluble collagen to soluble gelatin is the key to the industrial production of gelatin&#46; This process can produce different types of gelatin&#44; depending on the breakage of the intramolecular bonds&#58; polygeline gelatins &#40;Hemoce<span class="elsevierStyleSup">&#174;</span>&#41;&#44; succinylated gelatin &#40;Gelofusine<span class="elsevierStyleSup">&#174;</span>&#41; and oxypolygelatin&#46; Succinylated gelatin &#40;modified gelatin&#41; does not contain calcium&#44; and is therefore compatible with blood products&#46; Due to its low molecular weight&#44; it has less expanding capacity and a shorter half-life &#40;2&#8211;3<span class="elsevierStyleHsp" style=""></span>h&#41; than other colloids&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The latest &#40;2006&#41; version of the summary of product characteristics states that Gelofusine &#8220;is a colloidal plasma substitute indicated for the initial management of hypovolaemic shock caused by&#44; for example&#44; haemorrhage&#44; acute trauma or surgery&#41; and in situations where volume replacement will improve tissue perfusion&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">31</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Hydroxyethyl starches &#40;HES&#41; are modified polysacharides derived from amylopectin obtained from maize or potato starch&#46; HES are classified according to their concentration&#44; molecular weight&#44; degree of molar substitution &#40;hydroxyethyl residues for every 10 glucose molecules&#41; and C2&#47;C6 ratio &#40;&#40;hydroxyethyl residues at the C2 atom are more resistant to plasma &#945;-amylase mediated hydroxyethylation than those at C6&#41;&#46; Concentration mainly affects initial volume expansion&#59; 6&#37; solutions are iso-oncotic&#44; and 10&#37; solutions are hyper-oncotic&#46; The molecular weight of HES determines their expansion capacity&#44; and this&#44; together with the molar substitution index and C2&#47;C6 ratio&#44; determines their intravascular half-life&#46;<a class="elsevierStyleCrossRef" href="#bib0555"><span class="elsevierStyleSup">32</span></a> Over the years&#44; new HES have been developed with lower molecular weights and molar substitution indexes and a higher C2&#47;C6 ratio&#44; making them less susceptible to degradation&#44; and thus increasing their intravascular half-life&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">These guidelines will focus on third generation&#44; 130&#47;0&#46;4&#47;6&#37; &#40;maize-based&#41; or 130&#47;0&#46;042&#47;6&#37; &#40;potato-based&#41; HES&#46; The latter formulation has a slightly higher molar substitution index &#40;0&#46;42 vs 0&#46;4&#41; and a lower C2&#47;C6 hydroxyethylation ratio&#44; and is therefore more resistant to hydrolysis&#46; Potato-derived HES has a lower degree of branching due to the predominance of substantially linear amylose chains&#44; in contrast to the highly-branched anylopectin-rich maize-based formulation&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Most HES are suspended in saline solution&#44; although the latest formulations are based on a balanced solution&#46;<a class="elsevierStyleCrossRefs" href="#bib0560"><span class="elsevierStyleSup">33&#8211;38</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">According to the summary of product characteristics&#44; HES are indicated in the treatment of hypovolaemia due to acute blood loss when crystalloids alone are not considered sufficient&#46; This summary was amended in January 2014<a class="elsevierStyleCrossRef" href="#bib0590"><span class="elsevierStyleSup">39</span></a> to include indications for administration&#44; recommending that the first 10&#8211;20<span class="elsevierStyleHsp" style=""></span>ml should be infused slowly and under careful monitoring&#46; The maximum daily dose is 30<span class="elsevierStyleHsp" style=""></span>ml&#47;kg and the lowest possible effective dose should be used&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The most important changes made in the summary involve contraindications for HES&#44; administration in patients with sepsis&#44; burn patients&#44; critically ill patients &#40;typically admitted to the intensive care unit&#41;&#44; patients with kidney failure or receiving renal replacement therapy&#44; and patients with intracranial or cerebral haemorrhage&#46; It also recommends restricting the use of HES to the initial phase of volume resuscitation&#44; with a maximum time interval of 24<span class="elsevierStyleHsp" style=""></span>h&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Scope and objectives</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Rationale and objectives</span><p id="par0135" class="elsevierStylePara elsevierViewall">The aim of these CPGs is to clarify concepts&#44; standardise procedures&#44; and provide a series of recommendations or safety suggestions based on the latest scientific evidence that will help clinicians take sound decisions relating to the use of postoperative intravenous fluids for volume resuscitation in non-cardiac surgery&#46; The recommendations in this guideline are aimed at non-cardiac surgical patients with slight to moderate bleeding that require volume resuscitation&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">For the purpose of these GPGs&#44; we will use the term perioperative fluid management&#46; Specific treatment of the secondary causes of blood loss will not be addressed&#46; These guidelines do not include children due to the unique characteristics&#44; both general and specific&#44; of the paediatric population&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Cardiac surgery has also been excluded because fluid management in these patients differs significantly from other clinical settings&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Healthcare region</span><p id="par0150" class="elsevierStylePara elsevierViewall">These guidelines are designed for use in the Spanish national health system&#46; The target users are healthcare professionals specialising in anaesthesiology and critical care&#44; surgery&#44; nursing and other fields associated with the perioperative care and treatment of non-cardiac surgery patients&#46;</p></span></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Methodology</span><p id="par0155" class="elsevierStylePara elsevierViewall">The development of these CPGs has been sponsored by the Spanish Society of Anaesthesiology and Critical Care Medicine &#40;SEDAR&#41; and drawn up by the Society&#39;s Haemostasis&#44; Transfusion and Critical Care Medicine division&#46; The aim has been to develop a series of recommendations for perioperative fluid management in surgical patients&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">These CPGs have been developed following the recommendations of the Spanish Health System Clinical Practice Guideline Development Manual&#46;<a class="elsevierStyleCrossRef" href="#bib0595"><span class="elsevierStyleSup">40</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">The guidelines were developed in stages&#58;</p><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Formation of the working group</span><p id="par0170" class="elsevierStylePara elsevierViewall">At this stage&#44; a working group made up of anaesthesiologists&#44; surgeons and surgical nurses involved in perioperative fluid management was formed&#44; together with experts in methodology from the Centro Cochrane Iberoamericano &#40;Barcelona&#41; and the Spanish Society of Anaesthesiology&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Clinical questions</span><p id="par0175" class="elsevierStylePara elsevierViewall">The clinical questions have been formulated according to the PICO &#40;population&#44; intervention&#44; comparison and outcome&#41; format and discussed by the members of the working group&#46; They were prioritised according to the objectives&#44; scope&#44; target population&#44; clinical areas and target users of the recommendations&#46; In order to prioritise outcomes&#44; 4 anaesthesiologists individually and independently rated 24 outcomes on a scale of 1&#8211;9&#44; where a score of 1&#8211;3 corresponded to an unimportant outcome&#44; 4&#8211;6 to an important outcome&#44; and 7&#8211;9 to a critical outcome&#46; Table S1 summarises the score for each outcome&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Safety was prioritised according to key outcomes of interest to patients&#46; The main safety outcome was the adverse effects of different interventions&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Literature search</span><p id="par0185" class="elsevierStylePara elsevierViewall">A two-stage bibliographic search of research articles published since 2000 was conducted to address the questions formulated&#46; In the first stage&#44; the MEDLINE bibliographic database accessed through PubMed &#40;including the systematic reviews published in the Cochrane Database of Systematic Reviews&#41; was searched for CPGs&#44; systematic reviews &#40;SR&#41; and other position papers&#44; together with health technology assessment reports&#46; The search strategy is described in Table S2&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">In the second stage&#44; the search focussed on retrieving specific studies that added further information to the relevant SRs&#46; Of these&#44; only randomised clinical trials &#40;RCT&#41; were chosen&#46; The search was also performed in MEDLINE&#44; and was not limited by language&#46; However&#44; for the purpose of analysis&#44; only articles written in English and Spanish were chosen&#46; The search was performed in November 2013&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Study selection and evaluation of evidence</span><p id="par0195" class="elsevierStylePara elsevierViewall">The articles retrieved from the bibliographic search were first filtered by title and abstract to determine their relevance to the clinical questions&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows the article selection process in the form of a flow diagram&#46; Studies discussing formulations no longer in use in Spain&#44; such as polygelines&#44; dextrans&#44; second generation HES and earlier formulations&#44; or those no longer marketed&#44; such as oxypolygelatin&#44; were excluded from the analysis&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0200" class="elsevierStylePara elsevierViewall">The working group decided to restrict the SRs selected to primary studies published after 2000&#44; on the grounds that surgical and anaesthetic techniques can differ greatly in studies performed before and after this date&#46; Studies published by Joachim Boldt were also excluded because they have been rejected by the scientific community and withdrawn by journals following revelations of research misconduct&#46; Relevant references included on the basis of the title and abstract were then read in their entirety to determine their quality and suitability&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">The quality of the evidence was evaluated following the recommendations of the international working group <span class="elsevierStyleItalic">Grading of Recommendations of Assessment Development and Evaluations</span> &#40;GRADE&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0600"><span class="elsevierStyleSup">41</span></a> The quality of the available body of evidence was evaluated for each outcome included in the clinical question&#46; The following factors were taken into consideration&#58; risk of bias&#44; consistency of results across studies&#44; directness of evidence&#44; precision of effect estimates&#44; and publication bias&#46; Following this evaluation process&#44; the quality of the evidence gathered for each outcome was classified into 4 categories&#58; high&#44; moderate&#44; low&#44; or very low&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Use of resources and surgery costs were evaluated by prioritising questions that could provide recommendations on these topics&#46; The questions were prioritised during meetings of the working group&#44; and once the list of priorities had been drawn up&#44; the references retrieved from the above-mentioned bibliographic search were filtered by title and abstract&#46; Structured abstracts were analysed and the text of relevant articles read to evaluate their quality&#44; selecting those that directly addressed the questions of interest&#46; A narrative synthesis was made of the most important outcomes&#44; and a table was created specifically for the kidney disease outcome&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Formulation of recommendations</span><p id="par0215" class="elsevierStylePara elsevierViewall">Following the GRADE methodology&#44; recommendations were formulated on the basis of the summary of findings for each clinical question&#46; To determine the direction &#40;in favour or against an intervention&#41; and the strength of the recommendations &#40;strong or weak&#41;&#44; the overall quality of the available evidence&#44; the risk&#47;benefit ratio of each procedure evaluated&#44; patient values and preferences&#44; and if applicable&#44; use of resources and associated costs&#44; were weighed up&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Members of the working group were asked to give their opinion of the summaries of findings and the resulting recommendations on the basis of the comprehensiveness&#44; relevance and outcomes of the articles evaluated&#46; Following this&#44; the recommendations were discussed in a group meeting&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">These guidelines have been reviewed independently by a multidisciplinary group of professionals from the Spanish Society of General and Digestive Surgery&#44; the Spanish Society of Anaesthesiology&#44; Intensive Care and Pain Therapy&#44; the Spanish Society of Surgical Nursing&#44; and the Spanish Society of Nursing and Surgery&#46; The guidelines will be updated every 3 years&#44; or whenever specific recommendations need to be amended following the emergence of new scientific evidence&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Results</span><p id="par0230" class="elsevierStylePara elsevierViewall">To find the formulations &#40;colloids or crystalloids&#41; with the best safety profile for perioperative volume replacement in non-cardiac surgery&#44; 3 different comparisons were made of different colloids&#58; &#40;a&#41; albumin vs crystalloids&#44; &#40;b&#41; hydroxyethyl starch &#40;HES&#41; vs crystalloids&#44; and c&#41; gelatins vs crystalloids&#46; The overall quality of the evidence is low due to the risk of bias and the imprecision of the findings&#46; The characteristics of the studies included are shown in <a class="elsevierStyleCrossRef" href="#tbl0030">Table 4</a>&#46; The summary of findings and quality of evidence are shown in <a class="elsevierStyleCrossRefs" href="#tbl0035">Tables 5A&#8211;5C</a>&#46; The studies on which the evidence and recommendations for this question are based are shown in Table S3&#46; As far as the use of resources and care costs are concerned&#44; the results of an incremental cost-effectiveness ratio calculated in a clinical trial with a small sample size<a class="elsevierStyleCrossRef" href="#bib0605"><span class="elsevierStyleSup">42</span></a> showed that choosing colloids &#40;HES 130&#47;0&#46;4&#41; over crystalloids &#40;Ringer&#39;s Lactate&#41; to prevent complications in patients increased costs by &#36;70&#46;5&#46; In this study&#44; however&#44; more robust cost-effective measures were not calculated&#46; The quality of the studies analysed in the context of the outcomes of interest is shown in Table S4&#46; The impact of the kidney function outcome is detailed separately in Table S5&#46;<elsevierMultimedia ident="tbl0005"></elsevierMultimedia></p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><elsevierMultimedia ident="tbl0035"></elsevierMultimedia><elsevierMultimedia ident="tbl0040"></elsevierMultimedia><elsevierMultimedia ident="tbl0045"></elsevierMultimedia><p id="par0235" class="elsevierStylePara elsevierViewall">To find the colloid solution with the best safety profile for perioperative volume replacement in non-cardiac surgery&#44; 3 different comparisons were made of different colloids&#58; &#40;a&#41; albumin vs HES&#44; &#40;b&#41; modified gelatin vs HES&#44; and &#40;c&#41; HES 130&#47;0&#46;42 vs HES 130&#47;0&#46;4&#46; The overall quality of the evidence is low due to the risk of bias and the imprecision of the findings&#46; The characteristics of the studies included are shown in <a class="elsevierStyleCrossRef" href="#tbl0050">Table 6</a>&#46; The summary of findings and quality of evidence are shown in <a class="elsevierStyleCrossRefs" href="#tbl0055">Tables 7A&#8211;7C</a>&#46; The studies on which the evidence and recommendations for this question are based are shown in Table S6&#46; The quality of the studies analysed in the context of the outcomes of interest is shown in Table S7&#46; The impact of the kidney function outcome is detailed separately in Table S8&#46;<elsevierMultimedia ident="tbl0010"></elsevierMultimedia></p><elsevierMultimedia ident="tbl0050"></elsevierMultimedia><elsevierMultimedia ident="tbl0055"></elsevierMultimedia><elsevierMultimedia ident="tbl0060"></elsevierMultimedia><elsevierMultimedia ident="tbl0065"></elsevierMultimedia></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Discussion and recommendations</span><p id="par0240" class="elsevierStylePara elsevierViewall">These guidelines focus on perioperative volume replacement in non-cardiac surgery patients with moderate or severe blood loss who need fluid management strategies to maintain appropriate intravascular volume and tissue perfusion&#46; The onset of massive haemorrhage will require specific treatment that is beyond the scope of these guidelines&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">Intravenous fluids are given to all surgical patients&#46; However&#44; the need for this therapy has diminished following the introduction of fast track surgery&#44; less invasive techniques&#44; and shorter preoperative fasting&#46;<a class="elsevierStyleCrossRefs" href="#bib0420"><span class="elsevierStyleSup">5&#44;38&#44;43</span></a></p><p id="par0250" class="elsevierStylePara elsevierViewall">Most medical procedures vary greatly in clinical practice&#46; Incorrect fluid administration can be harmful to patients&#44; and most practitioners have a limited understanding of the benefits and risks of fluid management&#46;<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">13&#44;21</span></a></p><p id="par0255" class="elsevierStylePara elsevierViewall">Surgical practice in Spain should mirror the results of a study conducted in Catalonia in 2006&#44;<a class="elsevierStyleCrossRef" href="#bib0615"><span class="elsevierStyleSup">44</span></a> in which 22&#46;6&#37; of surgical patients received on average 500<span class="elsevierStyleHsp" style=""></span>ml of colloids&#46; In a recent meta-analysis&#44;<a class="elsevierStyleCrossRef" href="#bib0525"><span class="elsevierStyleSup">26</span></a> the crystalloid&#47;colloid ratio in surgical patients was 1&#58;5 &#40;750<span class="elsevierStyleHsp" style=""></span>ml crystalloids for every 500<span class="elsevierStyleHsp" style=""></span>ml colloids&#41;&#46; Since 2000&#44; this ratio has decreased&#44; and now more colloids than crystalloids are administered to these patients&#46; The study found significant variability in the volume of crystalloids administered concurrently with colloids&#44; above all in terms of study population heterogeneity&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">Improved understanding among clinicians with regard to which fluids should be used and how they should be administered will improve management of hypovolaemia and standardise the indication for and management of fluids&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">This review has enabled us to make strong recommendations for some solutions over others in respect of the critical perioperative outcomes of interest &#40;Table S1&#41;&#46; The overall quality of the evidence is low due to the high to moderate risk of bias and the imprecision of the findings&#46; The low grade of scientific evidence and the absence of data relating to certain outcomes in these guidelines are due to the scant number of RCTs conducted in surgical patients&#46; In the few studies published&#44; the sample size is small and the results largely inconsistent&#44;<a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">33</span></a> in contrast to studies in critically ill patients&#44; which are usually multicentre RCTs with large cohorts&#46;<a class="elsevierStyleCrossRefs" href="#bib0620"><span class="elsevierStyleSup">45&#8211;49</span></a></p><p id="par0270" class="elsevierStylePara elsevierViewall">Only 5 of the 11 studies reviewed evaluated kidney function as an outcome of interest in the comparison of crystalloids with colloids<a class="elsevierStyleCrossRefs" href="#bib0605"><span class="elsevierStyleSup">42&#44;50&#8211;53</span></a> &#40;Table S5&#41;&#46; With the exception of Yates et al&#46;<a class="elsevierStyleCrossRef" href="#bib0655"><span class="elsevierStyleSup">52</span></a> with 200 patients&#44; all these studies involved a small sample size&#46; The fluids compared were mainly Ringer&#39;s Lactate&#44; in the case of crystalloids&#44; and HES in the case of colloids&#46; Follow-up was limited to the hospital stay&#44; and serum creatinine levels were used to monitor impairment of kidney function in all studies&#46; Taken together&#44; the studies reviewed found that perioperative kidney function was not significantly impaired&#44; irrespective of the type of fluid administered&#46;</p><p id="par0275" class="elsevierStylePara elsevierViewall">Only 6 of the 16 studies reviewed<a class="elsevierStyleCrossRefs" href="#bib0645"><span class="elsevierStyleSup">50&#44;54&#8211;58</span></a> &#40;246 patients&#41; evaluated kidney function following administration of the different colloids evaluated in these guidelines&#46; Serum creatinine was measured to monitor kidney function&#44; except in Yassen at al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0685"><span class="elsevierStyleSup">58</span></a> where it was measured on the RIFLE scale&#46; Sample size was small in all studies &#40;&#60;100 patients&#41;&#44; and follow-up was limited to the hospital stay&#46; None of the studies reported significant changes in kidney functions among the different colloids evaluated&#46;</p><p id="par0280" class="elsevierStylePara elsevierViewall">As crystalloids are a more cost-effective therapy and have not been shown to be inferior to colloids&#44; they would seem to be the best option for most patients&#44; and are also recommended in fast-track&#44; minimally invasive surgery&#46;</p><p id="par0285" class="elsevierStylePara elsevierViewall">These guidelines have not evaluated the haemodynamic effectiveness of colloid therapy&#46; The expansion capacity of these solutions is well-documented &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 3</a>&#41;&#44; and the correct indication for crystalloids or concurrent crystalloid-colloid therapy will depend on the dose given&#44; the duration of treatment&#44; the speed with which volume must be replaced&#44; and the haemodynamic status and clinical context of the patient&#46;<a class="elsevierStyleCrossRef" href="#bib0525"><span class="elsevierStyleSup">26</span></a> In all events&#44; it is important to note that colloids restore the fluid balance faster&#44; at a lower dosage&#44; and with less risk of tissue oedema than crystalloids&#46;<a class="elsevierStyleCrossRefs" href="#bib0480"><span class="elsevierStyleSup">17&#44;23&#44;59</span></a> They are indicted for fast volume replacement&#46; However&#44; in perioperative non-cardiac patients they should only be used under the circumstances and at the dose recommended in the summary of characteristics of each product&#46;</p><p id="par0290" class="elsevierStylePara elsevierViewall">Colloids are usually indicated when rapid volume replacement is needed to treat hypovolaemia secondary to haemorrhage&#44; trauma or sepsis&#44; and in patients in whom volume replacement will improve tissue perfusion when crystalloids alone are not sufficient&#46;<a class="elsevierStyleCrossRefs" href="#bib0535"><span class="elsevierStyleSup">28&#44;31&#44;39</span></a> Clinical parameters and&#47;or goal-directed fluid management monitoring parameters will help quantify replacement&#46; In addition&#44; indications and&#47;or limitations are specific to each type of colloid&#44; and the recommendations given in the summary of product characteristics should be followed&#46;<a class="elsevierStyleCrossRefs" href="#bib0535"><span class="elsevierStyleSup">28&#44;31&#44;39</span></a></p><p id="par0295" class="elsevierStylePara elsevierViewall">In the absence of evidence for or against&#44; when colloids are considered necessary or advisable&#44; we suggest choosing a fluid on the basis of its expansion capacity&#44; intravascular half life&#44; the characteristics of the carrier solution&#44; the availability of the product&#44; and the experience of the anaesthesiologist&#46; For the purpose of these guidelines&#44; however&#44; synthetic colloids are recommended over albumin due to the lack of scientific evidence and the expense of albumin therapy&#46; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> shows a fluid management algorithm for surgical patients&#46;<a class="elsevierStyleCrossRef" href="#bib0790"><span class="elsevierStyleSup">79</span></a></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0300" class="elsevierStylePara elsevierViewall">In addition to the recommendations given in these guidelines in respect of the questions formulated&#44; the NICE<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">5</span></a> guidelines recommend a number of strategies to improve fluid administration&#46; Among these&#44; they suggest that hospitals should provide the resources needed to facilitate monitoring fluid administration&#44; provide professionals with the training they need in this regard&#44; and audit and review fluid prescribing protocols and patient outcomes&#46; All healthcare professionals involved in the prescription and administration of fluids should understand the physiology of fluids and electrolytes&#46;</p><p id="par0305" class="elsevierStylePara elsevierViewall">Some guidelines accepted by the scientific community<a class="elsevierStyleCrossRefs" href="#bib0410"><span class="elsevierStyleSup">3&#44;5</span></a> include recommendations that cannot easily be implemented in clinical practice in Spain&#46; These include reducing preoperative fasting&#44; preoperative administration of carbohydrate-rich liquids to reduce thirst&#44; anxiety and postoperative nausea and vomiting&#44;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">3</span></a> and reconsidering postoperative fluid management in patients capable of resuming oral intake of liquids&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">5</span></a> The use of mechanical flow regulators &#40;Dosi-Flow<span class="elsevierStyleSup">&#174;</span>&#41; or electronic devices such as infusion pumps facilitates IV fluid administration in surgical patients&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conclusion</span><p id="par0310" class="elsevierStylePara elsevierViewall">One of the most important contributions made by these guidelines lies in separating surgical patients from critically ill or septic patients&#44; in whom HES is ruled out&#46; We have also focussed on studies on crystalloids and&#47;or colloids published in Spain over the past 15 years&#46; To simplify decision-making and streamline our recommendations&#44; we have expressly excluded from our analysis any products that are not longer marketed or that have been replaced by more recent formulations&#44; such as dextrans&#44; first and second generation HES and polygeline gelatins&#44; which are now only rarely used&#46; Finally&#44; we have adopted the GRADE methodology&#44; which is now considered the gold standard for CPGs&#46;</p><p id="par0315" class="elsevierStylePara elsevierViewall">The main limitations of these guidelines are&#44; firstly&#44; the paucity of evidence available from studies on the critical outcomes of interest in the perioperative context&#46; Secondly&#44; uncertainties persist with regard to dosage&#44; duration of treatment and adverse effects relating to the use of crystalloids and&#47;or colloids in surgical patients&#46; Thirdly&#44; the studies reviewed did not evaluate the clinical condition of the patients&#44; such as heart&#44; respiratory&#44; kidney&#44; and liver failure and neurological dysfunction&#59; these are important factors to be considered in fluid management&#46;</p><p id="par0320" class="elsevierStylePara elsevierViewall">These recommendations can be adopted at no additional expense&#44; and this&#44; coupled with the widespread practice of administering fluids to surgical patients&#44; is a facilitating factor for the implementation of these guidelines&#46;</p><p id="par0325" class="elsevierStylePara elsevierViewall">However&#44; implementation could be hindered by the limited range of fluids available in some hospitals&#44; the lack of solid evidence to justify the introduction of changes in intraoperative fluid management strategies&#44; and the resistance of some clinicians&#44; who attach little importance to the choice of one fluid over another&#46;</p><p id="par0330" class="elsevierStylePara elsevierViewall">Implementation of most of these recommendations will not increase costs&#44; although colloids are more expensive than crystalloids&#46; The guidelines were drafted over a period of 12 months&#44; and should therefore be updated within 4 years of their publication&#46; Meanwhile&#44; if evidence comes to light that significantly modifies the approach to volume replacement in our patients&#44; SEDAR and the working group will issue an alert notice&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Funding</span><p id="par0335" class="elsevierStylePara elsevierViewall">The Spanish Society of Anaesthesiology and Critical Care Medicine has received funding from <span class="elsevierStyleGrantSponsor" id="gs1">Fresenius-Kabi</span> for the development of these guidelines &#40;Asociaci&#243;n Colaboraci&#243;n Cochrane Iberoamericana&#41;&#46; Fresenius-Kabi has not contributed to the design of these guidelines&#44; neither has had access to the results or participated in drafting the manuscript&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">CPG working group</span><p id="par0340" class="elsevierStylePara elsevierViewall">Pablo Alonso&#44; Instituto de Investigaci&#243;n Biom&#233;dica Sant Pau&#46; Barcelona&#46; INPECS &#40;Instituto para la Excelencia Cl&#237;nica y Sanitaria&#41;&#46;</p><p id="par0345" class="elsevierStylePara elsevierViewall">Dimelza Osorio&#44; Instituto de Investigaci&#243;n Biom&#233;dica Sant Pau&#46; Barcelona&#46; INPECS &#40;Instituto para la Excelencia Cl&#237;nica y Sanitaria&#41;&#46;</p><p id="par0350" class="elsevierStylePara elsevierViewall">Montserrat Ortega Urbaneja&#44; Registered Nurse Hospital Universitario Infanta Leonor&#44; Madrid&#46;</p><p id="par0355" class="elsevierStylePara elsevierViewall">Jos&#233; Manuel Ram&#237;rez&#44; Head of General and Digestive Surgery Hospital Cl&#237;nico Lozano Blesa&#46; Associate professor&#44; University of Zaragoza&#46;</p><p id="par0360" class="elsevierStylePara elsevierViewall">Melchor Javier Ripoll&#233;s&#44; Specialist in Anaesthesiology and Critical Care Medicine Hospital Universitario Infanta Leonor&#44; Madrid&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflict of interests</span><p id="par0365" class="elsevierStylePara elsevierViewall">Fresenius Kabi funded the bibliographic search performed by SEDAR and the methodology&#46; Fresenius-Kabi has not contributed to the design of these guidelines&#44; neither has it had access to the results or conclusions&#46;</p><p id="par0370" class="elsevierStylePara elsevierViewall">Dr&#46; Basora has received speaker&#39;s fees from Octapharma SA&#44; Fresenius-Kabi&#44; Vifor pharma SL and Masimo corporation&#59; Dr&#46; Colomina has received speaker&#39;s fees from Octapharma SA and has been sponsored by Baxter to attend conferences&#59; Dr&#46; Moral has received fees from the Hospital Sant Pau for educational programmes&#59; Dr&#46; Asuero has received speaker&#39;s fees from Fresenius-Kabi&#44; Dr&#46; Boix has no conflicts of interest to declare&#59; Dr Jove has receive speaker&#39;s fees from Incliva&#59; Dr&#46; Rodrigo has receive speaker&#39;s fees from Baxter and Edwards&#59; Dr&#46; J&#46; Ripoll&#233;s has received fees from Fresenius-Kabi and Edwards Lifesciences&#44; and has been sponsored by Deltex Medical and Braun to attend conferences&#59; Dr&#46; Calvo and J&#46;C&#46; Lau have no conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The present clinical practice guide responds to the clinical questions about security in the choice of fluid &#40;crystalloid&#44; colloid or hydroxyethyl starch 130&#41; in patients who require volume replacement during perioperative period of non-cardiac surgeries&#46; From the evidence summary&#44; recommendations were made following the GRADE methodology&#46; In this population fluid therapy based on crystalloids is suggested &#40;weak recommendation&#44; low quality evidence&#41;&#46; In the events where volume replacement is not reached with crystalloids&#44; the use of synthetic colloids &#40;hydroxyethyl starch 130 or modified fluid gelatin&#41; is suggested instead of 5&#37; albumin &#40;weak recommendation&#44; low quality evidence&#41;&#46; The choice and dosage of the colloid should be based in the product characteristics&#44; patient comorbidity and anesthesiologist&#39;s experience&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Esta Gu&#237;a de Pr&#225;ctica Cl&#237;nica responde a preguntas cl&#237;nicas sobre seguridad en la elecci&#243;n de fluido &#40;cristaloide&#44; coloide o Hidroxietilalmid&#243;n 130&#41; en pacientes que precisan restauraci&#243;n vol&#233;mica en el periodo perioperatorio de cirug&#237;a no cardiaca&#46; A partir del resumen de la evidencia&#44; se elaboraron las recomendaciones siguiendo la metodolog&#237;a GRADE&#46; En esta poblaci&#243;n se sugiere la fluidoterapia basada en la administraci&#243;n de cristaloides&#44; &#40;recomendaci&#243;n d&#233;bil&#44; calidad de la evidencia baja&#41;&#46; En las situaciones en las que la restauraci&#243;n vol&#233;mica no se alcance s&#243;lo con cristaloides&#44; se sugiere utilizar coloides sint&#233;ticos &#40;Hidroxietilalmid&#243;n 130 o gelatina fluida modificada&#41; en lugar de Alb&#250;mina 5&#37; &#40;recomendaci&#243;n d&#233;bil&#44; calidad de la evidencia baja&#41;&#46; La elecci&#243;n y dosificaci&#243;n de coloide deber&#225;n basarse en las caracter&#237;sticas del producto&#44; comorbilidad del paciente y experiencia del anestesi&#243;logo&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0175">Please cite this article as&#58; Basora M&#44; Colomina MJ&#44; Moral V&#44; Asuero de Lis MS&#44; Boix E&#44; Jover JL&#44; et al&#46; Gu&#237;a de pr&#225;ctica cl&#237;nica para la elecci&#243;n del fluido de restauraci&#243;n vol&#233;mica perioperatoria en los pacientes adultos intervenidos de cirug&#237;a no cardiaca&#46; Rev Esp Anestesiol Reanim&#46; 2016&#59;63&#58;29&#8211;47&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar9175">This article is part of the Anaesthesiology and Resuscitation Continuing Medical Education Program&#46; An evaluation of the questions on this article can be made through the Internet by accessing the Education Section of the following web page&#58; <span class="elsevierStyleInterRef" id="intr0915" href="http://www.elsevier.es/redar">www&#46;elsevier&#46;es&#47;redar</span></p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar8175">GU&#205;A DE PR&#193;CTICA CL&#205;NICA&#46; Promotor&#58; SEDAR Sociedad Espa&#241;ola de Anestesiolog&#237;a&#44; Reanimaci&#243;n y Terap&#233;utica del Dolor&#46; Secci&#243;n de Hemostasia&#44; Medicina Transfusional y Fluidoterapia de la SEDAR&#46;</p>"
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Volume replacement algorithm in non-cardiac surgery&#46;</p>"
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        "identificador" => "tbl0015"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Clinical situation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Indication&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Recommended fluid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Resuscitation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Urgent administration of fluids to restore circulation to vital organs after bleeding&#44; loss of plasma&#44; excessive loss of fluids and electrolytes &#40;usually through the digestive tract&#41; or internal losses &#40;redistribution secondary to sepsis&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Crystalloid or colloid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Routine maintenance&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Administration of IV fluids in patients who cannot take oral or enteral fluids&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Crystalloids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Volume replacement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Correct fluid and&#47;or electrolyte deficit due to urinary or gastrointestinal losses&#44; or elevated insensible losses due to fever or burns&#46; Some GI or kidney fluid losses can be high in sodium&#44; chloride and water content&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Crystalloids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Redistribution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Usually found in septic or critical patients&#44; or following major surgery or in patients with significant comorbidities&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Crystalloids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Reassess indications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Reassess fluid status daily according to the clinical condition of the patient and their fluid and&#47;or electrolyte needs&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Crystalloids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Indications for fluid management according to clinical situation<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">5</span></a></p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Na<span class="elsevierStyleSup">&#43;</span>mmol&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cl<span class="elsevierStyleSup">&#8722;</span>mmol&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">K<span class="elsevierStyleSup">&#43;</span>mmol&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Ca<span class="elsevierStyleSup">&#43;&#43;</span>mmol&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mg<span class="elsevierStyleSup">&#43;&#43;</span>mmol&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Buffer&#47;Bicarbonatemmol&#47;l&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Osm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">pH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Price<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> &#40;&#8364;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Plasma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">135&#8211;141&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95&#8211;105&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;5&#8211;4&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;2&#8211;2&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&#8211;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">289&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">0&#46;9&#37; Saline&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">154&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">154&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">308&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;30&#8211;1&#46;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ringer &#40;lactate&#47;acetate&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">130&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">109&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28 Lactate&#47;acetate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">273&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;09&#8211;1&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Balance&#44; calcium-free solution &#40;Plasmalyte<span class="elsevierStyleSup">&#174;</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">140&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 Acetate23 Gluconate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">295&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Balance solution with calcium &#40;Isofundin<span class="elsevierStyleSup">&#174;</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">145&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">127&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 Acetate5 Malate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">309&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;1&#8211;5&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Recommended retail price&#46; Cat&#225;logo 2014 Medicamentos&#46; Madrid&#58; Consejo General de Colegios Oficiales de Farmac&#233;uticos&#44; 2014&#46; ISBN13&#58; 978-84-87276-82-8&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the principle crystalloids used&#46;</p>"
        ]
      ]
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        "tipo" => "MULTIMEDIATABLA"
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        "tabla" => array:2 [
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Molecule&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Origin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Molecular weight &#40;daltons&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Amylopectin&#47;amylose content &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">C<span class="elsevierStyleInf">2</span>&#47;C<span class="elsevierStyleInf">6</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Initial expansion &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Elimination&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Carrier solution&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Price<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a> &#40;&#8364;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HES 130&#47;0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Maize&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">130&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">99&#37;&#47;&#60;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#47;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Renal clearance and plasma amylase&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ClNa 0&#46;9&#37; and balanced&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HES 130&#47;0&#46;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Potato&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">130&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75&#37;&#47;25&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#47;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Renal clearance and plasma amylase&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ClNa 0&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Succinylated gelatin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bovine collagen&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&#8211;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Renal clearance and peptidase&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ClNa 0&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Polygelines&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bovine collagen&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">70&#8211;80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Renal clearance and peptidase&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ClNa 0&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Not in Spain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Albumin 5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Human plasma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67&#44;000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Reticuloendothelial system&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">ClNa 0&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">92&#46;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            0 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Recommended retail price&#46; Cat&#225;logo 2014 Medicamentos&#46; Madrid&#58; Consejo General de Colegios Oficiales de Farmac&#233;uticos&#44; 2014&#46; ISBN13&#58; 978-84-87276-82-8&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the principle colloids used&#46;</p>"
        ]
      ]
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        "identificador" => "tbl0030"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">GRADE summary of findings and quality of evidence tables&#46;</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">High quality&#58; further research is very unlikely to change our confidence in the estimate of effect&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Moderate quality&#58; further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate&#46;</p><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Low quality&#58; further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate&#46;</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Very low quality&#58; we are very uncertain about the estimate&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Included in systematic review&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Type of surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Crystalloid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Albumin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Hydroxyethyl starch&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Gelatin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Other fluid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Evans<a class="elsevierStyleCrossRef" href="#bib0695"><span class="elsevierStyleSup">60</span></a> 2003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Perel<a class="elsevierStyleCrossRef" href="#bib0700"><span class="elsevierStyleSup">61</span></a> 2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hip replacement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;9&#37; saline &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Albumin 20&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Modified gelatin 3&#37; &#40;Gelofusine&#41; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Polygeline &#40;Haemaccel&#41; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Feldheiser<a class="elsevierStyleCrossRef" href="#bib0660"><span class="elsevierStyleSup">53</span></a> 2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Study retrieved from supplementary search&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Surgical debulking of ovarian cancer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Balanced crystalloid &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HES 6&#37; 130&#47;0&#46;4 &#40;Voluven&#41; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fries<a class="elsevierStyleCrossRef" href="#bib0705"><span class="elsevierStyleSup">62</span></a> 2004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Perel<a class="elsevierStyleCrossRef" href="#bib0700"><span class="elsevierStyleSup">61</span></a> 2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Knee arthroplasty&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ringer&#39;s lactate &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Modified gelatin 4&#37; &#40;Gelofusine&#41; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HES 200&#47;0&#46;5 6&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hamaji<a class="elsevierStyleCrossRef" href="#bib0650"><span class="elsevierStyleSup">51</span></a> 2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Study retrieved from supplementary search&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hip replacement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ringer&#39;s lactate &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HES 6&#37; 130&#47;0&#46;4 &#40;Voluven&#41; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hung<a class="elsevierStyleCrossRef" href="#bib0710"><span class="elsevierStyleSup">63</span></a> 2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Gillies<a class="elsevierStyleCrossRef" href="#bib0715"><span class="elsevierStyleSup">64</span></a> 2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Abdominal surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ringer&#39;s lactate &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HES 6&#37; 130&#47;0&#46;4 &#40;Voluven&#41; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Innerhofer<a class="elsevierStyleCrossRef" href="#bib0720"><span class="elsevierStyleSup">65</span></a> 2002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Groeneveld<a class="elsevierStyleCrossRef" href="#bib0570"><span class="elsevierStyleSup">35</span></a> 2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Knee arthroplasty&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ringer&#39;s lactate &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Modified gelatin 4&#37;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>Ringer&#39;s lactate &#40;Gelofusine&#41; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HES 200&#47;0&#46;5 6&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Jin<a class="elsevierStyleCrossRef" href="#bib0725"><span class="elsevierStyleSup">66</span></a> 2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Van der Linden<a class="elsevierStyleCrossRef" href="#bib0585"><span class="elsevierStyleSup">38</span></a> 2013 and Hartog<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">30</span></a> 2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cancer-related gastrectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ringer&#39;s lactate &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HES 6&#37; 130&#47;0&#46;4 &#40;Voluven&#41; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Modified gelatin 4&#37; &#40;Gelofusine&#41; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Parker<a class="elsevierStyleCrossRef" href="#bib0730"><span class="elsevierStyleSup">67</span></a> 2004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Saw<a class="elsevierStyleCrossRef" href="#bib0735"><span class="elsevierStyleSup">68</span></a> 2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hip replacement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;9&#37; saline &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>198&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Modified gelatin 4&#37; &#40;Gelofusine&#41; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>198&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Rasmussen<a class="elsevierStyleCrossRef" href="#bib0605"><span class="elsevierStyleSup">42</span></a> 2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Study retrieved from supplementary search&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cystectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ringer&#39;s lactate &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HES 6&#37; 130&#47;0&#46;4 &#40;Voluven&#41; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yang<a class="elsevierStyleCrossRef" href="#bib0645"><span class="elsevierStyleSup">50</span></a> 2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mutter<a class="elsevierStyleCrossRef" href="#bib0740"><span class="elsevierStyleSup">69</span></a> 2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hepatectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ringer&#39;s lactate &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Albumin 20&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HES 130&#47;0&#46;4&#37;&#44; 6&#37; &#40;Voluven&#41; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yates<a class="elsevierStyleCrossRef" href="#bib0655"><span class="elsevierStyleSup">52</span></a> 2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Study retrieved from supplementary search&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Colectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Balanced crystalloid &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HES 6&#37; 130&#47;0&#46;4 &#40;Voluven&#41; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>106&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab972117.png"
              ]
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Characteristics of studies used to compare the safety of crystalloids and colloids in volume replacement&#46;</p>"
        ]
      ]
      6 => array:7 [
        "identificador" => "tbl0035"
        "etiqueta" => "Table 5A"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">CI&#58; confidence interval&#59; RR&#58; risk ratio&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Quality assessment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Patients&#44; n</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Effect</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Quality&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Importance of outcome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Outcome &#40;number of clinical trials&#58;ref&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Albumin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Crystalloids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Relative &#40;CI 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Absolute<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mortality &#40;2&#41;&#58;50&#44;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#47;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#47;39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Not assessable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Not assessable due to no events in at least one group<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8853;Very low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Critical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kidney failure &#40;defined by author&#41; &#40;1&#41;&#58;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#47;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#47;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Not assessable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Not assessable due to no events in at least one group<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">c</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">d</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8853;Very low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Critical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Coagulopathy&#58; intraoperative blood loss &#40;ml&#41; &#40;1&#41;&#58;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14<span class="elsevierStyleHsp" style=""></span>ml more &#40;from 119&#46;24 less to 147&#46;24 more&#41;<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">d</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0045"><span class="elsevierStyleSup">f</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8853;Very low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Critical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Clinical haemorrhage &#40;1&#41;&#58;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#47;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#47;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Not assessable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Not assessable due to no events in at least one group<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">c</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">d</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0045"><span class="elsevierStyleSup">f</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8853;Very low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Critical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Venous thrombosis &#40;1&#41;&#58;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#47;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#47;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RR 1&#46;50 &#40;0&#46;58&#8211;3&#46;90&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100 cases more per 1000 &#40;from 84 less to 580 more&#41;<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">d</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0045"><span class="elsevierStyleSup">f</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8853;Very low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Important&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Length of ICU stay &#40;days&#41; &#40;1&#41;&#58;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;1 day less &#40;from 0&#46;52 less to 0&#46;32 more&#41;<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">d</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0045"><span class="elsevierStyleSup">f</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0050"><span class="elsevierStyleSup">g</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8853;&#8853;Low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Important&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Length of hospital stay &#40;days&#41; &#40;1&#41;&#58;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;from 0&#46;40 less to 0&#46;40 more&#41;<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">d</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0045"><span class="elsevierStyleSup">f</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0050"><span class="elsevierStyleSup">g</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8853;Very low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Important&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab972116.png"
              ]
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          ]
          "notaPie" => array:8 [
            0 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Assumed risk is based on the median risk for all control group studies&#46; The corresponding risk &#40;with 95&#37; CI&#41; is based on the assumed risk in the comparison group and the relative effect of the intervention &#40;with 95&#37; CI&#41;&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0020"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Generation of randomisation sequence and allocation unclear&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0025"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Few events&#46; The 95&#37; confidence interval includes zero&#46;</p>"
            ]
            3 => array:3 [
              "identificador" => "tblfn0030"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0030">No events presented&#46; RR not assessable&#46;</p>"
            ]
            4 => array:3 [
              "identificador" => "tblfn0035"
              "etiqueta" => "d"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0035">Important losses to follow-up&#46;</p>"
            ]
            5 => array:3 [
              "identificador" => "tblfn0040"
              "etiqueta" => "e"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0040">Only one study with events&#46;</p>"
            ]
            6 => array:3 [
              "identificador" => "tblfn0045"
              "etiqueta" => "f"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0045">Major heterogeneity I2 75&#37; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;003&#46;</p>"
            ]
            7 => array:3 [
              "identificador" => "tblfn0050"
              "etiqueta" => "g"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0050">The 95&#37; confidence interval includes zero&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Summary of findings and quality of evidence&#58; albumin vs crystalloids &#40;question 1&#41;&#46;</p>"
        ]
      ]
      7 => array:7 [
        "identificador" => "tbl0040"
        "etiqueta" => "Table 5B"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">CI&#58; confidence interval&#59; RR&#58; risk ratio&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Quality assessment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Patients&#44; n</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Effect</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Quality&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Importance of outcome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Outcome &#40;number of clinical trials&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#40;HES MP 130&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Crystalloids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Relative &#40;CI 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Absolute<a class="elsevierStyleCrossRef" href="#tblfn0055"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mortality &#40;5&#41;&#58;50&#8211;53&#44;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#47;221&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#47;209&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RR 2&#46;57 &#40;0&#46;7&#8211;9&#46;49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 more per 1000 &#40;from 3 less to 81 more&#41;<a class="elsevierStyleCrossRef" href="#tblfn0060"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0065"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8853;&#8853;Low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Critical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kidney failure &#40;defined by author&#41; &#40;4&#41;&#58;50&#8211;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#47;180&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#47;173&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RR 5&#46;79 &#40;0&#46;7&#8211;47&#46;67&#41;<a class="elsevierStyleCrossRef" href="#tblfn0060"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0065"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8853;Very low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Critical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">RIFLE at risk or very serious &#40;1&#41;&#58;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#47;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#47;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RR 0&#46;32 &#40;0&#46;01&#8211;7&#46;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 less per 1000 &#40;from 40 less to 261 more&#41;<a class="elsevierStyleCrossRef" href="#tblfn0060"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0065"><span class="elsevierStyleSup">b</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0070"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8853;&#8853;Low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Critical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Acute pulmonary oedema &#40;1&#41;&#58;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#47;106&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#47;100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RR 2&#46;36 &#40;0&#46;47&#8211;11&#46;88&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 more per 1000 &#40;from 11 less to 218 more&#41;<a class="elsevierStyleCrossRef" href="#tblfn0065"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8853;&#8853;&#8853;Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Critical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Coagulopathy&#58; intraoperative blood loss &#40;ml&#41; &#40;3&#41;&#58;50&#44;63&#44;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33&#46;73<span class="elsevierStyleHsp" style=""></span>ml less &#40;from 180&#46;18 less to 112&#46;73 more&#41;<a class="elsevierStyleCrossRef" href="#tblfn0060"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0075"><span class="elsevierStyleSup">d</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0080"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8853;Very low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Critical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Coagulopathy&#58; Blood loss up to 1st POP day &#40;accumulative&#44; ml&#41; &#40;3&#41;&#58;42&#44;51&#44;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">147&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">140&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">329&#46;6<span class="elsevierStyleHsp" style=""></span>ml more &#40;from 69&#46;48 less to 728&#46;67 more&#41;<a class="elsevierStyleCrossRef" href="#tblfn0060"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0080"><span class="elsevierStyleSup">e</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0085"><span class="elsevierStyleSup">f</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8853;Very low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Critical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Myocardial infarction &#40;1&#41;&#58;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#47;106&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#47;100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RR 2&#46;59 &#40;0&#46;85&#8211;7&#46;88&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64 more per 1000 &#40;from 6 less to 275 more&#41;<a class="elsevierStyleCrossRef" href="#tblfn0070"><span class="elsevierStyleSup">c</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0080"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8853;&#8853;&#9675;&#9675;Low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Important&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sepsis &#40;1&#41;&#58;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#47;106&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#47;100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RR 1&#46;53 &#40;0&#46;66&#8211;3&#46;54&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42 more per 1000 &#40;from 27 less to 203 more&#41;<a class="elsevierStyleCrossRef" href="#tblfn0070"><span class="elsevierStyleSup">c</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0080"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8853;&#8853;Low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Important&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Length of ICU stay &#40;days&#41; &#40;1&#41;&#58;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;1 less &#40;0&#46;51 less to 0&#46;31 more&#41;<a class="elsevierStyleCrossRef" href="#tblfn0060"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0070"><span class="elsevierStyleSup">c</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0080"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8853;&#8853;Low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Important&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "notaPie" => array:7 [
            0 => array:3 [
              "identificador" => "tblfn0055"
              "etiqueta" => "&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0055">Estimated risk is based on the median risk for all control group studies&#46; The corresponding risk &#40;with 95&#37; CI&#41; is based on the assumed risk in the comparison group and the relative effect of the intervention &#40;with 95&#37; CI&#41;&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0060"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0060">Randomisation sequence unclear&#44; or no randomisation&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0065"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0065">Few events&#46; The 95&#37; confidence interval includes zero&#46;</p>"
            ]
            3 => array:3 [
              "identificador" => "tblfn0070"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0070">Only one study&#46;</p>"
            ]
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              "identificador" => "tblfn0075"
              "etiqueta" => "d"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0075">Major heterogeneity I2 77&#37; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;01&#46;</p>"
            ]
            5 => array:3 [
              "identificador" => "tblfn0080"
              "etiqueta" => "e"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0080">The 95&#37; confidence interval includes zero&#46;</p>"
            ]
            6 => array:3 [
              "identificador" => "tblfn0085"
              "etiqueta" => "f"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0085">Major heterogeneity I2 79&#37; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;009&#46;</p>"
            ]
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          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Summary of findings and quality of evidence&#58; hydroxyethyl starch &#40;HES&#41; MP 130 vs crystalloids &#40;question 1&#41;&#46;</p>"
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">CI&#58; confidence interval&#59; RR&#58; risk ratio&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Quality assessment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Patients&#44; n</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Effect</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Quality&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Importance of outcome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Number of clinical trials&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Modified gelatin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Crystalloids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Relative &#40;CI 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Absolute<a class="elsevierStyleCrossRef" href="#tblfn0090"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mortality &#40;3&#41;&#58;60&#46;62&#44;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&#47;232&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#47;232&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RR 2&#46;11 &#40;0&#46;98 to 4&#46;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">43 more per 1000 &#40;from 1 less to 138 more&#41;<a class="elsevierStyleCrossRef" href="#tblfn0095"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0100"><span class="elsevierStyleSup">b</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0105"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8853;&#8853;Low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Critical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Coagulopathy&#58; intraoperative blood loss &#40;ml&#41; &#40;2&#41;&#58;65&#8211;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;33<span class="elsevierStyleHsp" style=""></span>ml more &#40;from 50&#46;14 less to 50&#46;8 more&#41;<a class="elsevierStyleCrossRef" href="#tblfn0095"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0105"><span class="elsevierStyleSup">c</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0110"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8853;Very low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Critical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Coagulopathy&#58; blood loss up to 1st day POP &#40;ml&#41; &#40;1&#41;&#58;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34<span class="elsevierStyleHsp" style=""></span>ml more &#40;from 120&#46;88 less to 188&#46;88 more&#41;<a class="elsevierStyleCrossRef" href="#tblfn0095"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0100"><span class="elsevierStyleSup">b</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0105"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8853;Very low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Critical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Heart failure &#40;1&#41;&#58;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#47;198&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#47;198&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RR 1&#46;62 &#40;0&#46;69&#8211;3&#46;83&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25 more per 1000 &#40;from 13 less to 114 more&#41;<a class="elsevierStyleCrossRef" href="#tblfn0105"><span class="elsevierStyleSup">c</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0110"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8853;&#8853;Low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Important&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Myocardial infarction &#40;1&#41;&#58;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#47;198&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#47;198&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RR 3 &#40;0&#46;12&#8211;73&#46;2&#41;<a class="elsevierStyleCrossRef" href="#tblfn0105"><span class="elsevierStyleSup">c</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0110"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8853;&#8853;&#9675;&#9675;Low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Important&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Venous thrombosis &#40;1&#41;&#58;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#47;198&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#47;198&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RR 1 &#40;0&#46;29&#8211;3&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 less per 1000 &#40;from 18 less to 61 more&#41;<a class="elsevierStyleCrossRef" href="#tblfn0105"><span class="elsevierStyleSup">c</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0110"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8853;&#8853;&#8853;Moderate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Important&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0090">Estimated risk is based on the median risk for all control group studies&#46; The corresponding risk &#40;with 95&#37; CI&#41; is based on the assumed risk in the comparison group and the relative effect of the intervention &#40;with 95&#37; CI&#41;&#46;</p>"
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              "identificador" => "tblfn0095"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0095">Generation of randomisation sequence and allocation unclear&#46; Some non-blinded studies&#46;</p>"
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              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0100">Only one study with events&#46;</p>"
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          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Summary of findings and quality of evidence&#58; modified gelatin vs crystalloids &#40;question 1&#41;&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Study&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Included in systematic review&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Type of surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Albumin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Hydroxyethyl starch&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Gelatin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Other fluid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Other fluid&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Godet<a class="elsevierStyleCrossRef" href="#bib0665"><span class="elsevierStyleSup">54</span></a> 2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bunn<a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">33</span></a> 2012&#44; Mutter<a class="elsevierStyleCrossRef" href="#bib0740"><span class="elsevierStyleSup">69</span></a> 2013 and Toomtong<a class="elsevierStyleCrossRef" href="#bib0745"><span class="elsevierStyleSup">70</span></a> 2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Vascular surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HES 6&#37; 130&#47;0&#46;4 &#40;Voluven&#41; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Modified gelatin 3&#37; &#40;Plasmion&#41; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Jin<a class="elsevierStyleCrossRef" href="#bib0725"><span class="elsevierStyleSup">66</span></a> 2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bunn<a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">33</span></a> 2012&#44; Hartog<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">30</span></a> 2011 and Van der Linden<a class="elsevierStyleCrossRef" href="#bib0585"><span class="elsevierStyleSup">38</span></a> 2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Gastrectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HES 6&#37; 130&#47;0&#46;4 &#40;Voluven&#41; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Modified gelatin 4&#37; &#40;Gelofusine&#41; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ringer&#39;s lactate &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Kim<a class="elsevierStyleCrossRef" href="#bib0750"><span class="elsevierStyleSup">71</span></a> 2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Van der Linden<a class="elsevierStyleCrossRef" href="#bib0585"><span class="elsevierStyleSup">38</span></a> 2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Major non-cardiac surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Albumin 20&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HES 6&#37; 130&#47;0&#46;4 &#40;Voluven&#41; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Liang<a class="elsevierStyleCrossRef" href="#bib0755"><span class="elsevierStyleSup">72</span></a> 2006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hartog<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">30</span></a> 2011 and Saw<a class="elsevierStyleCrossRef" href="#bib0735"><span class="elsevierStyleSup">68</span></a> 2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Large bowel resection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HES 6&#37; 130&#47;0&#46;4 &#40;Voluven&#41; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Gelatin &#40;succinyl gelatin&#41; 4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ringer&#39;s lactate &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mahmood<a class="elsevierStyleCrossRef" href="#bib0670"><span class="elsevierStyleSup">55</span></a> 2007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bunn<a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">33</span></a> 2012 and Toomtong<a class="elsevierStyleCrossRef" href="#bib0745"><span class="elsevierStyleSup">70</span></a> 2010&#44; Mutter<a class="elsevierStyleCrossRef" href="#bib0740"><span class="elsevierStyleSup">69</span></a> 2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Aortic surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HES 6&#37; 130&#47;0&#46;4 &#40;Voluven&#41; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Gelatin 4&#37; &#40;Gelofusine&#41; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HES 200&#47;0&#46;62 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mittermayr<a class="elsevierStyleCrossRef" href="#bib0760"><span class="elsevierStyleSup">73</span></a> 2007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bunn<a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">33</span></a> 2012&#44; Groeneveld<a class="elsevierStyleCrossRef" href="#bib0570"><span class="elsevierStyleSup">35</span></a> 2011 and Hartog<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">30</span></a> 2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Orthopaedic surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HES 6&#37; 130&#47;0&#46;4 &#40;Voluven&#41; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Gelatin 4&#37; &#40;Gelofusine&#41; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ringer&#39;s lactate &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mukhtar<a class="elsevierStyleCrossRef" href="#bib0675"><span class="elsevierStyleSup">56</span></a> 2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bunn<a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">33</span></a> 2012 and Mutter<a class="elsevierStyleCrossRef" href="#bib0740"><span class="elsevierStyleSup">69</span></a> 2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Liver transplant recipients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Albumin 5&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HES 6&#37; 130&#47;0&#46;4 &#40;Voluven&#41; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Staikou<a class="elsevierStyleCrossRef" href="#bib0765"><span class="elsevierStyleSup">74</span></a> 2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Study retrieved from supplementary search&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Abdominal surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HES 6&#37; 130&#47;0&#46;4 &#40;Voluven&#41; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>25&#41; vs HES 6&#37; 130&#47;0&#46;42 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>24&#41; &#40;Venofundin&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Topcu<a class="elsevierStyleCrossRef" href="#bib0770"><span class="elsevierStyleSup">75</span></a> 2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Study retrieved from supplementary search&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Major orthopaedic surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HES 6&#37; 130&#47;0&#46;4 &#40;Voluven&#41; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Gelatin 4&#37; &#40;succinyl gelatin&#41; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ringer&#39;s lactate &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Volta<a class="elsevierStyleCrossRef" href="#bib0775"><span class="elsevierStyleSup">76</span></a> 2007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bunn<a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">33</span></a> 2012 and Hartog<a class="elsevierStyleCrossRef" href="#bib0545"><span class="elsevierStyleSup">30</span></a> 2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Major cancer-related abdominal surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HES 6&#37; 130&#47;0&#46;4 &#40;Voluven&#41; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Polygeline 4&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ringer&#39;s lactate &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Wu<a class="elsevierStyleCrossRef" href="#bib0680"><span class="elsevierStyleSup">57</span></a> 2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Gattas<a class="elsevierStyleCrossRef" href="#bib0780"><span class="elsevierStyleSup">77</span></a> 2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Kidney transplant&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HES 6&#37; 130&#47;0&#46;4 &#40;Voluven&#41; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Gelatin 4&#37; &#40;succinyl gelatin&#41; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yang<span class="elsevierStyleSup">x</span> 2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Bunn<a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">33</span></a> 2012 and Mutter<a class="elsevierStyleCrossRef" href="#bib0740"><span class="elsevierStyleSup">69</span></a> 2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Hepatectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Albumin 20&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HES 6&#37; 130&#47;0&#46;4 &#40;Voluven&#41; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Ringer&#39;s lactate &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yassen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0685"><span class="elsevierStyleSup">58</span></a> 2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mutter<a class="elsevierStyleCrossRef" href="#bib0740"><span class="elsevierStyleSup">69</span></a> 2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Liver transplant recipients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Albumin 4&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HES 6&#37; 130&#47;0&#46;4 &#40;Voluven&#41; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Zdolsek<a class="elsevierStyleCrossRef" href="#bib0785"><span class="elsevierStyleSup">78</span></a> 2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Gattas<a class="elsevierStyleCrossRef" href="#bib0780"><span class="elsevierStyleSup">77</span></a> 2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Orthopaedic surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">HES 6&#37; 130&#47;0&#46;4 &#40;Voluven&#41; vs HES 6&#37; 130&#47;0&#46;4 &#40;Venofundin&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dextran 70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">CI&#58; confidence interval&#59; RR&#58; risk ratio&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Quality assessment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Patients&#44; n</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Effect</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Quality&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Importance of outcome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Number of clinical trials&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Albumin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HES&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Relative &#40;CI 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Absolute<a class="elsevierStyleCrossRef" href="#tblfn0115"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mortality &#40;up to hospital discharge&#41; &#40;2&#41;&#58;50&#8211;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#47;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#47;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RR 1 &#40;0&#46;07&#8211;14&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 less per 1000 &#40;from 20 less to 302 more&#41;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8853;&#8853;Low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Critical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Impairment of kidney function &#40;RIFLE risk&#41; &#40;2&#41;&#58;50&#44;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#47;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#47;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RR 2 &#40;0&#46;31&#8211;12&#46;84&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36 more per 1000 &#40;from 25 less to 423 more&#41;<a class="elsevierStyleCrossRef" href="#tblfn0120"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0125"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8853;Very low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Critical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Renal replacement therapy &#40;1&#41;&#58;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#47;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#47;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RR 1 &#40;0&#46;07&#8211;14&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 less per 1000 &#40;from 47 less to 695 more&#41;<a class="elsevierStyleCrossRef" href="#tblfn0120"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0130"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8853;Very low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Critical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Intraoperative blood loss &#40;1&#41;&#58;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47 more &#40;from 92&#46;75 less to 186&#46;75 more&#41;<a class="elsevierStyleCrossRef" href="#tblfn0120"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8853;&#8853;Low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Critical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Blood loss at 24<span class="elsevierStyleHsp" style=""></span>hours POP &#40;ml&#41; &#40;1&#41;&#58;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">203 more &#40;from 7&#46;97 to 398&#46;03 more&#41;<a class="elsevierStyleCrossRef" href="#tblfn0130"><span class="elsevierStyleSup">c</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0135"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8853;&#8853;Low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Critical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Blood loss at 72<span class="elsevierStyleHsp" style=""></span>hours POP &#40;ml&#41; &#40;1&#41;&#58;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">228 more &#40;from 49&#46;08 less to 505&#46;08 more&#41;<a class="elsevierStyleCrossRef" href="#tblfn0120"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0130"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8853;Very low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Critical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Time on ventilation &#40;days&#41; &#40;2&#41;&#58;56&#46;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;18 less &#40;from 1&#46;42 less to 1&#46;06 more&#41;<a class="elsevierStyleCrossRef" href="#tblfn0125"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8853;&#8853;Low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Critical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab972125.png"
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            ]
          ]
          "notaPie" => array:5 [
            0 => array:3 [
              "identificador" => "tblfn0115"
              "etiqueta" => "&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0115">Assumed risk is based on the median risk for all control group studies&#46; The corresponding risk &#40;with 95&#37; CI&#41; is based on the assumed risk in the comparison group and the relative effect of the intervention &#40;with 95&#37; CI&#41;&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0120"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0120">Very wide CI that includes zero&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0125"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0125">Incomplete follow-up data&#46;</p>"
            ]
            3 => array:3 [
              "identificador" => "tblfn0130"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0130">Blinding unclear&#46;</p>"
            ]
            4 => array:3 [
              "identificador" => "tblfn0135"
              "etiqueta" => "d"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0135">Very wide CI&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Summary of findings and quality of evidence table&#58; albumin vs hydroxyethyl starch &#40;HES&#41; &#40;question 2&#41;&#46;</p>"
        ]
      ]
      11 => array:7 [
        "identificador" => "tbl0060"
        "etiqueta" => "Table 7B"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">CI&#58; confidence interval&#59; RR&#58; risk ratio&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Quality assessment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; patients</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Effect</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Quality&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Importance of outcome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Number of clinical trials&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Modified gelatin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HES&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Relative &#40;CI 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Absolute<a class="elsevierStyleCrossRef" href="#tblfn0140"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mortaligy &#40;at 28 or 30 days&#41; &#40;2&#41;&#58;54&#44;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#47;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#47;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RR 2&#46;39 &#40;0&#46;37&#8211;15&#46;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">77 more per 1000 &#40;from 35 less to 793 more&#41;<a class="elsevierStyleCrossRef" href="#tblfn0145"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0150"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8853;&#8853;Low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Critical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Renal replacement therapy &#40;1&#41;&#58;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#47;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#47;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">RR 1 &#40;0&#46;07&#8211;14&#46;95&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 less per 1000 &#40;from 44 less to 664 more&#41;<a class="elsevierStyleCrossRef" href="#tblfn0145"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0155"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8853;&#8853;Low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Critical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Blood loss at 24<span class="elsevierStyleHsp" style=""></span>hours POP &#40;ml&#41; &#40;4&#41;&#58;55&#44;66&#44;72&#44;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#46;47 less &#40;from 68&#46;35 less to 25&#46;41 more&#41;<a class="elsevierStyleCrossRef" href="#tblfn0145"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0155"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8853;&#8853;Low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Critical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "notaPie" => array:4 [
            0 => array:3 [
              "identificador" => "tblfn0140"
              "etiqueta" => "&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0140">Assumed risk is based on the median risk for all control group studies&#46; The corresponding risk &#40;with 95&#37; CI&#41; is based on the assumed risk in the comparison group and the relative effect of the intervention &#40;with 95&#37; CI&#41;&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0145"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0145">Very wide CI that includes zero&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0150"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0150">Small sample size&#44; few events&#46;</p>"
            ]
            3 => array:3 [
              "identificador" => "tblfn0155"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0155">Blinding unclear&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Summary of findings and quality of evidence&#58; modified gelatin vs hydroxyethyl starch &#40;HES&#41; &#40;question 2&#41;&#46;</p>"
        ]
      ]
      12 => array:7 [
        "identificador" => "tbl0065"
        "etiqueta" => "Table 7C"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">CI&#58; confidence interval&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Quality assessment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Patients</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Effect</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Quality&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Importance of outcome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Number of clinical trials&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HES 130&#47;0&#46;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HES 130&#47;0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Relative &#40;CI 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Absolute<a class="elsevierStyleCrossRef" href="#tblfn0160"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Intraoperative blood loss &#40;1&#41;&#58;78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28 more &#40;from 188&#46;99 less to 244&#46;99 more&#41;<a class="elsevierStyleCrossRef" href="#tblfn0165"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0170"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8853;Very low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Critical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "notaPie" => array:3 [
            0 => array:3 [
              "identificador" => "tblfn0160"
              "etiqueta" => "&#42;"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0160">Assumed risk is based on the median risk for all control group studies&#46; The corresponding risk &#40;with 95&#37; CI&#41; is based on the assumed risk in the comparison group and the relative effect of the intervention &#40;with 95&#37; CI&#41;&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0165"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0165">Blinding unclear&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0170"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0170">Very wide CI that includes zero&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">Summary of findings and quality of evidence table&#58; comparison 3&#58; HES 130&#47;0&#46;42 vs HES 130&#47;0&#46;4 &#40;question 2&#41;&#46;</p>"
        ]
      ]
      13 => array:5 [
        "identificador" => "upi0005"
        "tipo" => "MULTIMEDIAECOMPONENTE"
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        "mostrarDisplay" => true
        "Ecomponente" => array:2 [
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      14 => array:5 [
        "identificador" => "tbl0005"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Question 1&#46; Which type of fluid &#40;colloids or crystalloids&#41; has the best safety profile for perioperative volume replacement in non-cardiac surgery&#63;</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Recommendation</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">In patients undergoing non-cardiac surgery&#44; fluid management with crystalloids are recommended over colloids&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Weak recommendation in favour</span> &#40;Low quality of evidence&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Justification</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top">Available studies have not shown any difference between the use of colloids and crystalloids in terms of critical outcomes such as mortality&#44; impairment of kidney function and coagulopathy&#44; among others&#46; The quality of the evidence is low&#44; and colloids are more expensive than crystalloids&#46; For these reasons&#44; a weak recommendation is given in favour of crystalloids&#46;</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Research recommendations</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top">Clinical trials of a higher methodological quality with more appropriate sample sizes are needed to investigate critical outcomes&#46; Studies evaluating the cost-effectiveness of treatment strategies are also needed&#46;</td></tr></tbody></table>
                  """
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        "tabla" => array:1 [
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Article information

ISSN: 23411929
Original language: English

DOI:10.1016/j.redare.2015.11.001

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2019 May	1	0	1
2018 October	0	1	1
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2017 April	19	6	25
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2017 January	19	8	27
2016 December	0	3	3
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2016 August	0	5	5
2016 July	0	2	2
2016 June	0	4	4
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2016 January	9	16	25

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