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Plasma substitutes therapy in pediatrics.

Domenico Pietrini¹, Daniele De Luca, Federica Tosi

¹Pediatric Intensive Care Unit, University Hospital “A.Gemelli”, Università Cattolica del Sacro Cuore - Rome, Italy. d.pietrini@rm.unicatt.it

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|April 20, 2012

Summary

Hypovolemia in children requires careful fluid resuscitation. This review examines synthetic and non-synthetic colloids, comparing their pharmacodynamics for treating critical blood loss in pediatric patients.

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Area of Science:

Pediatric critical care medicine
Pharmacology
Fluid resuscitation

Background:

Hypovolemia is a leading cause of circulatory failure in children, potentially leading to organ damage.
Fluid administration is a common intervention for hemorrhagic shock, but fluid type choice remains debated in pediatrics.

Purpose of the Study:

To review the pharmacodynamics of synthetic and non-synthetic colloids used in pediatric fluid resuscitation.
To address controversies surrounding colloid use in children experiencing critical blood loss.

Main Methods:

Literature review focusing on pharmacodynamics of various fluid resuscitation agents.
Analysis of studies comparing crystalloids, albumin, gelatins, and hydroxyethylstarch (HES) in pediatric populations.

Main Results:

Crystalloids are cost-effective but offer less sustained volume expansion and are linked to adverse effects like edema.
Colloids, including gelatins and HES, provide more sustained intravascular volume, but pediatric data on HES efficacy and safety is limited.

Conclusions:

The choice of fluid resuscitation in pediatric hypovolemia impacts patient outcomes.
Further pediatric-specific research is needed to clarify the optimal use and safety of different colloid solutions.