Making catheter-related bloodstream infections history: from the slogan to the serious strategy.

less severe clinical bleeding and renal dysfunction. However, in their study, the range in subject ages and diagnoses coupled with only minimal short-term safety data make it impossible to determine even an estimate of the risks in comparison with albumin. With respect to the altered coagulation caused by HES 130/0.4, this study reports equivalence in blood loss; however, I do note that the HES 130/0.4 group received more fresh-frozen plasma. Fresh-frozen plasma exposure was protocol driven based on clinical bleeding and prothrombin times so it is probable that HES 130/0.4 did indeed make a clinically significant, but controlled deterioration in coagulation. There are reports of clinical bleeding after use of HES 130/0.4 over a wide range of uses (3). Clear signals exist in the literature that long lasting, osmotic renal damage occurs in the face of prior renal disease and exposure to colloid substitutes. There is accumulation of the colloid within renal cells with effects that are both short and long term (4). Renal failure does occur with HES 130/0.4 and it does not seem to be 100% predicable based on pretreatment renal function (5, 6). In addition, long lasting and severe pruritus can occur with HES 130/0.4 (7), and there is 41⁄2 times the incidence of potentially life-threatening anaphylactic reactions compared with albumin (3). HES colloids, in general, are relatively contraindicated in the face of sepsis where renal dysfunction and mortality is higher than with other colloids (8). Hanart et al report solid, but preliminary, data that HES 130/0.4 seems equivalent to albumin within the first 24 hours after uncomplicated pediatric cardiac surgery. Now we need an evaluation of long-term efficacy and safety in a multicentered, randomized block design with true blinding at all stages. We are now challenged to take on the question, “Is HES 130/0.4 equivalent in efficacy and safety to albumin for pediatric congenital cardiac surgery?” before a fiscal decision voids a decision based on quality of care. Brian D. Hanna, MD, PhD Division of Cardiology, Children’s Hospital of Philadelphia Pennsylvania, PA Department of Pediatrics, School of Medicine, University of Pennsylvania Pennsylvania, PA