The contrast agent Iotrolan 300 has potential advantages for bronchography over previous agents in that it can be injected directly through the bronchoscope and it does not obscure bronchoscopic vision or interfere with further bronchoscopic procedures. It was used for selective bronchography in 20 patients with suspected bronchiectasis. Side effects and change in FEVy and in arterial oxygen saturation were compared in these patients and in 14 patients undergoing bronchoscopy for suspected carcinoma. Thirteen of the 20 patients undergoing bronchography had side effects, mainly headache, nausea, and a feeling of heat or flushing. The fall in FEVy at four hours (0-3 1) did not differ from the fall in the control group (0'1 1). The fall in arterial oxygen saturation (Sao2) during bronchography (9-4%) did not differ significantly from the fall during bronchoscopy in the control group (6-1%). Iotrolan gave good quality bronchograms, which in all cases provided a diagnosis. Iotrolan appears to be suitable for bronchography by fibreoptic bronchoscope and to be well tolerated. Department of
The standard technique of selective bronchography via the fibreoptic bronchoscope using Dionosil aqueous suspension (Glaxo) as described by Flower and Shneerson (1984) has disadvantages. The medium is a thick suspension and is extremely difficult to inject. Direct injection into the suction channel may cause blockage if the channel is not adequately cleaned. Furthermore, Dionosil may induce chemical pneumonia, lung collapse and compromise of lung function if a large volume is used (Flower & Armstrong, 1986). It also augments the adverse effect of bronchoscopy on arterial oxygen saturation (Goldman et al, 1987). These difficulties have prompted the idea of using a different type of contrast medium that can be injected directly into the suction channel of the bronchoscope without the attendant complications. The physicochemical properties of iotrolan, a non-ionic dimer, suggest that it could be useful in selective bronchography. It is iso-osmolar with blood at a concentration of 240mgIml−1 with a viscosity of 3.9 cP at 37°C. At a concentration of 300 mgl ml−1 it is slightly hyperosmolar (320 m osm kg−1) and the viscosity is 8.1 cP at 37°C. Animal work and clinical evaluation have indicated that this medium is comparable in safety to the other low-osmolar media that are currently in wide clinical use, possibly with better neural tolerance (Hammer & Deisenhammer, 1985). The aim of this study was to assess the safety and efficacy of iotrolan 240 in a group of patients requiring selective bronchography.
Over half of patients receiving RRT on discharge from critical care in our network received a short period of single-organ renal support before step-down. This may represent either delayed discharge from critical care or a potential opportunity for care in an alternative high-dependency facility.
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