First use of hypertonic saline dextran in children: a study in safety and effectiveness for atrial septal defect
Roberto Rocha-E-Silva1, Luiz F Canêo, Domingos D Lourenço Filho
1Division of Surgery, São Paulo University School of Medicine, São Paulo, Brazil 05403-900. rors@terra.com.br
Insights
Hypertonic saline dextran is safe for pediatric cardiac surgery, reducing fluid balance and transfusion needs in children undergoing atrial septal defect repair. This study explored its use in pediatric cardiopulmonary bypass.
Area of Science:
- Pediatric Anesthesiology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Hypertonic saline dextran (HSD) is effective in adult shock and surgery.
- Pediatric use of HSD, particularly in cardiac surgery, remains uninvestigated.
- Atrial septal defect correction often involves cardiopulmonary bypass.
Purpose of the Study:
- To evaluate the safety and efficacy of HSD in pediatric patients undergoing atrial septal defect repair.
- To assess the impact of HSD on fluid balance, bleeding, and transfusion requirements.
- To determine optimal dosing for HSD in this pediatric surgical population.
Main Methods:
- Twenty-five pediatric patients undergoing atrial septal defect correction with cardiopulmonary bypass received varying doses of HSD.
- Patients were grouped into low-dose (0-1 mL/kg) and high-dose (2-4 mL/kg) HSD groups.
- Fluid balance, bleeding, transfusion needs, plasma sodium, and hematocrit were monitored.
Main Results:
- No HSD-related complications were observed in any patient.
- No significant difference in blood loss was found between low-dose and high-dose groups.
- The high-dose HSD group showed significantly reduced fluid balance and blood/derivative requirements.
Conclusions:
- HSD is safe for pediatric cardiopulmonary bypass during atrial septal defect repair.
- Effective HSD doses reduce fluid overload and the need for blood products in pediatric cardiac surgery.
- Further research into HSD's role in pediatric critical care is warranted.
Abstract:
Hypertonic saline dextran (7.5% NaCl + 6% Dextran-70) has been used in adults in several studies and shown beneficial effects in hypovolemic shock, trauma, cardiogenic shock, and cardiac surgery. There have never been studies of this solution in children. This work studies its effect in children undergoing surgery for the correction of atrial septal defects. Twenty-five children underwent correction of atrial septal defect using cardiopulmonary bypass with bloodless priming. Children were divided in five groups and each received an incremental hypertonic saline dextran dose of 0.1, 0.5, 1.0, 2.0, and 4.0 mL/kg, 5 min before the beginning of cardiopulmonary bypass. Collected data were fluid balance, amount of bleeding, blood/derivative transfusion occurrence, plasma sodium, and hematocrit. Patients were divided into low-dose (0-1 mL/kg) and high-dose (2-4 mL/kg) groups. Analysis of variance was used to determine differences in blood loss between groups. The fluid balance and blood/derivative requirements were compared through Student's t test and Fisher's exact test (2-tail), respectively. All patients were discharged from hospital with corrected atrial septal defect. No hypertonic saline dextran-related complications occurred. There were no differences in the amount of bleeding. The high-dose group exhibited a significant decrease in fluid balance and in blood/derivative requirements in comparison with the low-dose group. In this study, the use of hypertonic saline dextran in the pediatric population submitted to cardiopulmonary bypass is safe and does not raise the amount of bleeding. Its effective doses produce negative fluid balance and reduce blood/derivative requirements.
