title: Efficacy and safety of 6% hydroxyethyl starch 130/0.4 (Voluven) for perioperative volume replacement in children undergoing cardiac surgery: a propensity-matched analysis.
abstract: BACKGROUND
  Six percent hydroxyethyl starch (HES) 130/0.4 is considered an alternative to human albumin (HA) and crystalloids for volume replacement in children undergoing cardiac surgery. In this large propensity-matched analysis, we aimed to assess the efficacy and safety of replacing HA with HES for intraoperative volume therapy in children undergoing cardiac surgery with cardiopulmonary bypass (CPB).
  
  
  METHODS
  We retrospectively reviewed our database, including children who underwent cardiac surgery between January 2002 and December 2010. Four percent HA was used until 2005; it was replaced by HES thereafter. Demographic data, intra- and postoperative blood loss and blood component transfusions were recorded, together with the incidence of postoperative complications and mortality. We performed a propensity-matched analysis using 13 possible confounding factors to compare children who received either HES or HA intraoperatively. The primary objectives included the effects of both fluids on intraoperative fluid balance (difference between fluids in and fluids out (efficacy)) and blood loss and exposure to allogeneic blood products (safety). Secondary safety outcomes were mortality and the incidence of postoperative renal dysfunction.
  
  
  RESULTS
  Of 1,832 children reviewed, 1,495 were included in the analysis. Intraoperative use of HES was associated with a less positive fluid balance. Perioperative blood loss, volume of red blood cells and fresh frozen plasma administered, as well as the number of children who received transfusions, were also significantly lower in the HES group. No difference was observed regarding the incidence of postoperative renal failure requiring renal replacement therapy or of morbidity and mortality.
  
  
  CONCLUSIONS
  These results confirm that the use of HES for volume replacement in children during cardiac surgery with CPB is as safe as HA. In addition, its use might be associated with less fluid accumulation. Further large studies are needed to assess whether the reduction in fluid accumulation could have a significant impact on postoperative morbidity and mortality.
authors.affiliation: Department of Anesthesiology, University Hospital Brugmann and Queen Fabiola Children's University Hospital, Free University of Brussels, 4 Place Van Gehuchten, B-1020, Brussels, Belgium. philippe.vanderlinden@chu-brugmann.be.
authors.forename: Philippe
authors.initials: P
authors.lastname: Van der Linden
authors.affiliation: Department of Anesthesiology, University Hospital Brugmann and Queen Fabiola Children's University Hospital, Free University of Brussels, 4 Place Van Gehuchten, B-1020, Brussels, Belgium. melanie.dumoulin@ulb.ac.be.
authors.forename: Melanie
authors.initials: M
authors.lastname: Dumoulin
authors.affiliation: Department of Anesthesiology, University Hospital Brugmann and Queen Fabiola Children's University Hospital, Free University of Brussels, 4 Place Van Gehuchten, B-1020, Brussels, Belgium. celine.van.lerberghe@ulb.ac.be.
authors.forename: Celine
authors.initials: C
authors.lastname: Van Lerberghe
authors.affiliation: Department of Anesthesiology, University Hospital Brugmann and Queen Fabiola Children's University Hospital, Free University of Brussels, 4 Place Van Gehuchten, B-1020, Brussels, Belgium. cristel.sancheztorres@huderf.be.
authors.forename: Cristel Sanchez
authors.initials: CS
authors.lastname: Torres
authors.affiliation: Pediatric Intensive Care Unit, Queen Fabiola Children's University Hospital, Free University of Brussels, 15 Avenue JJ Crocq, B-1020, Brussels, Belgium. ariane.willems@huderf.be.
authors.forename: Ariane
authors.initials: A
authors.lastname: Willems
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA. davidfaraoni@icloud.com.
authors.forename: David
authors.initials: D
authors.lastname: Faraoni
mesh_terms: D000418:Albumins / Q000008:administration & dosage; D001803:Blood Transfusion; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D000077324:Crystalloid Solutions; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage*; D007223:Infant; D007552:Isotonic Solutions / Q000008:administration & dosage; D008297:Male; D019990:Perioperative Care; D010952:Plasma Substitutes / Q000008:administration & dosage*; D057216:Propensity Score; D016896:Treatment Outcome
chemical_list: D000418:Albumins; D000077324:Crystalloid Solutions; C485123:HES 130-0.4; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes