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Perioperative volume replacement in children undergoing cardiac surgery: albumin versus hydroxyethyl starch 130/0.4
Christophe Hanart1, Maher Khalife, Andrée De Villé
1Department of Anesthesiology, CHU Brugmann-HUDERF, Brussels, Belgium.
Insights
In pediatric cardiac surgery, 6% hydroxyethyl starch (HES) 130/0.4 is a cost-effective alternative to 4% albumin for fluid replacement, with similar blood loss but fewer transfusions needed in the HES group.
Area of Science:
- Anesthesiology
- Pediatric Cardiac Surgery
- Fluid Management
Background:
- Intraoperative fluid management is critical in pediatric cardiac surgery.
- Albumin and hydroxyethyl starch (HES) are commonly used colloids.
Purpose of the Study:
- To compare 4% albumin with 6% HES 130/0.4 for perioperative blood loss and fluid needs in pediatric cardiac surgery.
Main Methods:
- Prospective randomized study at a single university hospital.
- 119 children undergoing cardiac surgery with cardiopulmonary bypass were randomized.
- Received either 4% albumin or 6% HES 130/0.4 for fluid replacement.
Main Results:
- Intraoperative colloid volume was similar between groups.
- No significant difference in measured or calculated blood loss.
- Higher allogeneic blood transfusion rates in the albumin group (78% vs. 57%).
- Lower intraoperative fluid balance in the HES group.
Conclusions:
- 6% HES 130/0.4 is a viable alternative to 4% albumin for intraoperative fluid replacement in pediatric cardiac surgery.
- HES may be preferred due to lower cost.
- Postoperative outcomes were comparable.
Objective:
To compare 4% albumin with 6% hydroxyethyl starch (HES) 130/0.4 in terms of perioperative blood loss and intraoperative fluid requirements in children undergoing cardiac surgery.
Design:
Prospective randomized study.
Setting:
Single University Hospital.
Patients:
Pediatric patients undergoing cardiac surgery with cardiopulmonary bypass.
Interventions:
One hundred nineteen children were randomized to receive up to 50 mL.kg of either 4% albumin (Alb: n = 59) or 6% HES 130/0.4 (HES: n = 60) for intraoperative fluid volume replacement including the cardiopulmonary bypass priming fluid. Ringer's lactate was used for further intraoperative volume needs. Monitoring, anesthetic, and surgical techniques were standardized. Packed red blood cells were administered according to a strict transfusion protocol. Intra- and postoperative blood loss were measured and also calculated from children's estimated blood volume, pre- and postoperative hematocrit, and volume of transfused packed red blood cells.
Measurements And Main Results:
Volume of colloid used intraoperatively was similar in both groups (median [interquartiles]) (Alb: 50 [45-50] mL x kg; HES: 50 [37-50] mL x kg). Measured and calculated blood loss were not different between groups, but a higher number of children in the albumin group required allogeneic blood transfusion (78% vs. 57%; difference between proportions: 0.213; 95% confidence interval: 0.05-0.38; p = 0.0188). Intraoperative fluid balance was lower in the HES group (Alb 23 [11-39] mL x kg; HES: 12 [-5-30] mL x kg; p = 0.005). Postoperative outcome was not different between groups.
Conclusions:
In children undergoing cardiac surgery, 6% HES 130/0.4 may represent an interesting alternative to 4% albumin for intraoperative fluid volume replacement because of its lower cost.
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