title: Effect of 6% hydroxyethyl starch 130/0.4 in 0.9% sodium chloride (Voluven®) on complications after subarachnoid hemorrhage: a retrospective analysis.
abstract: BACKGROUND
  6% Hydroxyethyl Starch 130/0.4 in 0.9% Sodium Chloride (Voluven®; 6% HES 130/0.4) is a colloid often used for fluid resuscitation in patients with subarachnoid hemorrhage (SAH), despite a lack of safety data for this use. The purpose of our study was to evaluate the effect of 6% HES 130/0.4 on major complications associated with SAH.
  
  
  METHODS
  Medical records of all patients presenting between May 2010 and September 2012 with aneurysmal SAH were analyzed. Patients were divided in two groups based on the administration of 6% HES 130/0.4; HES group (n=57) and Non-HES group (n=72). The primary outcome included a composite of three major complications associated with SAH: Delayed Cerebral Ischemia (DCI), Hydrocephalus (HCP) requiring cerebrospinal fluid (CSF) shunting, and Rebleeding.
  
  
  RESULTS
  The study groups were similar with respect to most characteristics except the incidences of hypertension, ischemic heart disease, Fisher grade and lowest hemoglobin during stay. The odds of developing the primary composite outcome was higher in the HES group [OR= 3.1(1.30-7.36), p=0.01]. The patients in the HES group had a significantly longer median duration of hospital (19 vs 14 days) and Neurointensive Care Unit stay (14 vs 10 days) compared to the Non HES group.
  
  
  CONCLUSIONS
  We observed increased complications after SAH with 6% HES 130/0.4 (Voluven®) administration. An adequately powered prospective randomized controlled trial into the safety of 6% HES 130/0.4 in this patient population is warranted.
authors.affiliation: Department of Anesthesiology, Duke University Medical Centre, Durham, NC USA ; Department of Anesthesiology, Singapore General Hospital, Singapore, Singapore.
authors.forename: Shariq A
authors.initials: SA
authors.lastname: Khan
authors.forename: Owoicho
authors.initials: O
authors.lastname: Adogwa
authors.forename: Tong J
authors.initials: TJ
authors.lastname: Gan
authors.forename: Ulysses T
authors.initials: UT
authors.lastname: Null
authors.forename: Terence
authors.initials: T
authors.lastname: Verla
authors.forename: Sankalp
authors.initials: S
authors.lastname: Gokhale
authors.forename: William D
authors.initials: WD
authors.lastname: White
authors.forename: Gavin W
authors.initials: GW
authors.lastname: Britz
authors.forename: Ali R
authors.initials: AR
authors.lastname: Zomorodi
authors.forename: Michael L
authors.initials: ML
authors.lastname: James
authors.forename: David L
authors.initials: DL
authors.lastname: McDonagh
keywords: 6% HES 130/0.4; Delayed cerebral ischemia; Fluid therapy; Hydrocephalus; Hydroxyethyl starch; Mortality; Rebleeding; Subarachnoid hemorrhage; Voluven