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Is the use of colloids for fluid replacement harmless in children?

Sonja Saudan1

  • 1Pediatric Anesthesia Unit, Geneva Children's Hospital, University of Geneva Hospitals, Geneva, Switzerland. sonja.saudan@hcuge.ch

Current Opinion in Anaesthesiology
|April 14, 2010
PubMed

Insights

Tetrastarches are the preferred colloid solution for children, offering a better balance of cost and safety compared to older options. They present fewer risks to coagulation and kidney function, making them a safer choice.

Area of Science:

  • Pediatric critical care medicine
  • Pharmacology
  • Fluid resuscitation

Background:

  • Albumin, the traditional colloid osmotic pressure agent, faces challenges due to cost, unproven survival benefits, and viral transmission risks.
  • Synthetic colloids like hydroxyethyl starch and gelatin are increasingly used, each with distinct properties influencing efficacy and safety.
  • Understanding these differences is crucial for optimizing pediatric fluid management.

Purpose of the Study:

  • To review the advantages and disadvantages of various colloid solutions in pediatric patients.
  • To focus on the safety profiles of different colloid preparations.
  • To guide the selection of appropriate fluid therapies in children.

Main Methods:

  • Literature review of studies on colloid solutions in pediatric populations.
  • Comparative analysis of efficacy, safety, and adverse effect profiles.
  • Focus on physicochemical characteristics and clinical outcomes.

Main Results:

  • Dextrans are largely avoided due to adverse effects on coagulation and anaphylaxis risk.
  • Gelatin has limited volume expansion and a high potential for anaphylactoid reactions; albumin has minimal hemostatic impact.
  • Tetrastarches demonstrate improved safety regarding coagulation and renal function compared to older hydroxyethyl starches and are approved for pediatric use.
  • Plasma-adapted solutions for tetrastarches enhance safety for coagulation and acid-base balance.

Conclusions:

  • Tetrastarches represent the optimal current choice for pediatric fluid management, balancing cost-effectiveness and safety.
  • They are particularly suitable for children with normal pre-existing renal and coagulation function.
  • Further research may refine the use of synthetic colloids in specific pediatric scenarios.
Abstract

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