{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T14:07:08Z","timestamp":1776434828169,"version":"3.51.2"},"reference-count":35,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2022,4,27]],"date-time":"2022-04-27T00:00:00Z","timestamp":1651017600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Modified fluid gelatin 4% is approved for use in children, but there is still a surprising lack of clinical studies including large numbers of pediatric patients. Therefore, we performed a European prospective noninterventional multicenter study to evaluate the use of a modified fluid gelatin 4% in saline (sal\u2010GEL) or an acetate\u2010containing balanced electrolyte solution (bal\u2010GEL) in children undergoing major pediatric surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>The primary aim was to assess the indications and dosing of modified fluid gelatin, and the secondary aim was to assess the safety and efficacy, focusing, in particular, on routinely collected clinical parameters.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Children aged up to 12\u2009years with ASA risk scores of I\u2010III receiving sal\u2010GEL or bal\u2010GEL were followed perioperatively. Demographic data, surgical procedures performed, anesthesia, hemodynamic and laboratory data, adverse events, and adverse drug reactions were documented using a standardized case report form.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>601 children that were investigated at 13 European pediatric centers from May 2015 to March 2020 (sal\u2010GEL 20.1%, bal\u2010GEL 79.9%; mean age 29.1\u2009\u00b1\u200938.6 (range 0\u2013144) months; body weight 12.1\u2009\u00b1\u200910.5 (1.4\u201370) kg) were included in the analysis. The most frequent indications for GEL infusion were hemodynamic instability without bleeding (76.0%), crystalloids alone not being sufficient for hemodynamic stabilization (55.7%), replacement of preoperative deficit (26.0%), and significant bleeding (13.0%). Mean infused GEL volume was 13.0\u2009\u00b1\u20095.3 (2.4\u201337.5) ml\u2009kg<jats:sup>\u22121<\/jats:sup>. The total dose was affected by age, with higher doses in younger patients. After gelatin infusion, mean arterial pressure increased (mean change 8.5\u2009\u00b1\u20097.3 [95% CI: 8 to 9.1] mmHg), and the hemoglobin concentrations decreased significantly (mean change \u22121.1\u2009\u00b1\u20091.8 [95% CI: \u22121.2 to \u22120.9] g\u00b7dL<jats:sup>\u22121<\/jats:sup>). Acid\u2013base parameters were more stable with bal\u2010GEL. No serious adverse drug reactions directly related to gelatin (i.e., anaphylactoid reaction, clotting disorders, and renal failure) were observed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Moderate doses up to 20\u2009ml\u2009kg<jats:sup>\u22121<\/jats:sup> of modified fluid gelatin were infused most frequently to improve hemodynamic stability in children undergoing major pediatric surgery. The acid\u2013base balance was more stable when gelatin in a balanced electrolyte solution was used instead of saline. No serious adverse drug reactions associated with gelatin were observed.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.14459","type":"journal-article","created":{"date-parts":[[2022,4,15]],"date-time":"2022-04-15T08:52:19Z","timestamp":1650012739000},"page":"825-833","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Modified fluid gelatin 4% for perioperative volume replacement in pediatric patients (<scp>GPS<\/scp>): Results of a European prospective noninterventional multicenter study"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5850-7443","authenticated-orcid":false,"given":"Robert","family":"S\u00fcmpelmann","sequence":"first","affiliation":[{"name":"Clinic of Anaesthesiology Hannover Medical School  Hannover Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1160-1456","authenticated-orcid":false,"given":"Anna","family":"Camporesi","sequence":"additional","affiliation":[{"name":"Department of Pediatric Anesthesia and Intensive Care \"V. Buzzi\" Children's Hospital, University of Milan  Milan Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ignacio","family":"G\u00e1lvez","sequence":"additional","affiliation":[{"name":"Department of Pediatric Anesthesia University Hospital Son Espases  Palma de Mallorca Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dimitar","family":"Pechilkov","sequence":"additional","affiliation":[{"name":"Pediatric Cardiac Intensive Care Unit, Department of Pediatric Cardiology National Cardiology Hospital  Sofia Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"Eich","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Paediatric Intensive Care and Emergency Medicine Auf der Bult Children's Hospital  Hannover Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Franz\u2010Josef","family":"Kretz","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care Medicine Klinikum Stuttgart, Olgahospital  Stuttgart Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Remei","family":"Perera Sarri","sequence":"additional","affiliation":[{"name":"Department of Paediatric Anaesthesia University Hospital Vall d'Hebron  Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dora","family":"Tancheva","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Burn Injury Clinic University Hospital for Active Treatment and Emergency Medicine \"N.I. Pirogov\"  Sofia Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvia","family":"Serrano\u2010Casabon","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Hospital Sant Joan de Deu  Barcelona Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Murphy","sequence":"additional","affiliation":[{"name":"Department of Paediatric Anaesthesia Alder Hey Children's NHS Foundation Trust  Liverpool UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marinella","family":"Astuto","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care AOU Policlinico\u2010 San Marco Catania  Catania Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clelia","family":"Zanaboni","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia, Critical Care and Perinatal Medicine Istituto Giannina Gaslini  Genoa Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3781-8282","authenticated-orcid":false,"given":"Karin","family":"Becke","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care Cnopfsche Kinderklinik\/Klinik Hallerwiese  N\u00fcrnberg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3831-1608","authenticated-orcid":false,"given":"Nils","family":"Dennhardt","sequence":"additional","affiliation":[{"name":"Clinic of Anaesthesiology Hannover Medical School  Hannover Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,4,27]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.13007"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/ACO.0000000000000727"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e3181a7ec82"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1209759"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1460-9592.2011.03776.x"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/EJA.0000000000000780"},{"key":"e_1_2_9_8_1","unstructured":"EMA.https:\/\/www.ema.europa.eu\/en\/medicines\/human\/referrals\/hydroxyethyl\u2010starch\u2010hes\u2010containing\u2010medicinal\u2010products. 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