Use of Interventional Radiology in Critically Injured Children Admitted in a Pediatric Intensive Care Unit of a Developing Country

Abstract

ObjectiveThe aim of this study was to describe the outcome of the use of interventional radiological procedures (IRP) (angioembolization) in critically injured children.MethodsA retrospective review of medical records of all children who underwent an IRP from January 2010 to December 2015 was done. Data were collected on a structured proforma and results are presented as mean with standard deviation and frequency with percentages.ResultEighteen patients were identified who underwent IRP during the study period. The mean age was 10.4 ± 4.3 years and 10 (55%) were males. Ten patients had a road traffic accident, four had a history of fall, one patient had glass cut pelvic injury, and two patients had blunt abdominal trauma, while one patient had bleeding secondary to hemipelvectomy. The genitourinary system was involved in five patients, liver in four, and spleen in two and pancreas in one patient. Bleeding was from branches of internal iliac artery in seven patients, hepatic artery in three patients, splenic artery in two patients, and middle colic artery in one patient, while one patient had blood oozing from the bone after hemi-pelvictomy. Four French vascular access sheath was placed under ultrasound guidance; this was followed by the placement of C1 catheter (Cordis, Miami, FL). After vessel identification, a 2.7F Progreat microcatheter (Terumo, Tokyo) was used for super-selective cannulation of the bleeding vessel. Intravascular coil, polyvinyl alcohol (PVA) particles, or gel foam was used for the embolization of bleeding vessels. No procedural complications were observed except minor oozing in one patient. One patient expired due to multiorgan dysfunction.ConclusionAngioembolization is a useful and relatively safe procedure in the management of vitally stable children with hemorrhagic abdominopelvic injuries. However, further studies may be needed to evaluate the efficacy and cost-effectiveness of this practice, especially in resource-constrained settings.

Liver trauma: WSES 2020 guidelines

“…In children, the use of primary hepatic AE has been reported rarely and is debated even in the presence of arterial blush where it seems to increase NOM failure rates [55], or according to some studies, it does not correlate with decrease odds of laparotomy [30]. In the pediatric population, AE use is associated with older age and is not completely defined in terms of efficacy and cost-effectiveness, especially in low-resource settings [30,[55][56][57][58][59][60][61]. Some authors, however, identify the presence of active contrast extravasation as an independent predictor for pseudoaneurysm (PSA) formation in children, regardless of injury grade.…”

Retrospective assessment of developing liver injuries in children brought to the emergency room due to the blunt abdominal trauma over the past 10 years; a single -center experience.

“…In the literature, it was reported that 50 to 80% of laparotomies due to blunt liver trauma had no active bleeding and negative laparotomy was performed (22,23). Many studies have been managed to define specific criteria to facilitate the application of non-operative therapy and patient selection in cases with blunt trauma (1,24,25). These criteria were determined as hemodynamic stability, absence of peritoneal findings, less than 500 ml of hemoperitoneum.…”

Hyperchloremia and Its Association with Outcomes in Critically Ill Children

“…Copyright  Abbas Q post resuscitation HCMA in critically ill children. As lactic acidosis and hyperlactatemia are associated with high PICU mortality while hyperchloremia is result of isotonic fluid resuscitation [14,15]. So this debate of isotonic versus balanced salt solution in critically ill children continued [8] and till we have a final answer we should continue the use of isotonic saline for resuscitation as well as maintenance fluid therapy in critically ill children while carefully looking for the development of hyperchloremia.…”