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[Osmolality of contrast media--a risk factor in radiological endovascular procedures in children]
Insights
Radiocontrast agents (RCA) during interventions can disrupt blood colloid-osmotic equilibrium (COE). A new modulator infusion therapy effectively reduces these disruptions and prevents complications in pediatric patients.
Area of Science:
- Pediatric Radiology
- Interventional Radiology
- Nephrology
Context:
- Radiologically-guided endovascular (RIV) interventions in children often require radiocontrast agents (RCA).
- Bolus injection of RCA can lead to acute disorders in blood colloid-osmotic equilibrium (COE).
- The severity of COE disruption is influenced by the initial COE status and RCA osmolality.
Purpose:
- To evaluate the impact of radiocontrast agent injection on blood colloid-osmotic equilibrium in pediatric patients undergoing RIV interventions.
- To develop and test a novel modulator infusion therapy to mitigate RCA-induced COE disorders.
- To assess the efficacy of the proposed therapy in preventing osmoregulation complications.
Summary:
- Ninety children (5 months–14 years) undergoing RIV interventions received bolus injections of high-osmolality RCA or nonionic low-osmolality RCA.
- Significant acute disorders of blood COE were observed, particularly with high-osmolality RCA.
- A modulator infusion therapy, tailored to initial blood COE, was developed and demonstrated to significantly reduce COE disturbances.
Impact:
- The developed modulator infusion therapy effectively minimizes RCA-induced blood COE disorders in pediatric patients.
- This therapeutic approach helps prevent complications associated with disturbed osmoregulation during RIV procedures.
- Provides a strategy for safer contrast administration in pediatric interventional radiology.
Abstract:
The study was conducted in 90 children aged from 5 months to 14 years during radiologically-guided endovascular (RIV) interventions with bolus injection of radiocontrast agents (RCA) in a dose of 2-3 ml/kg for 2-3 sec. High-osmolality RCA were used in 80 children, an nonionic low-osmolality RCA omnipaque-300 in 10 children. Injection of RCA bolus was attended by marked acute disorders of blood colloidoosmotic equilibrium (COE) which depended on the initial status of the latter and were greater when high osmolality RCA were used. On the basis of the study results, the authors developed and tested a method of modulator infusion therapy with consideration for the initial blood COE (hyper-, normo-, hypoosmolality). The suggested therapy makes it possible to reduce the degree of blood COE disorders considerably and prevent the development of complications associated with disturbed osmoregulation.