title: Terlipressin as rescue therapy for intractable hypotension due to septic shock in children.
abstract: Intractable hypotension due to septic shock is associated with high mortality rates in critically ill children worldwide. The use of terlipressin (triglycyl-lysine-vasopressin), an analog of vasopressin with a longer duration of action, recently emerged as a treatment of hypotension not responsive to vasopressors and inotropes. This was a retrospective study set in an 18-bed pediatric critical care department in a tertiary care children's hospital. We reviewed the files of all children with septic shock who were treated with terlipressin between January 2003 and February 2004. Fourteen children (mean age, 5.6 years; range, 4 days to 17.7 years) were treated with terlipressin in 16 septic shock episodes. Significant improvements in respiratory and hemodynamic indices were noted shortly after treatment. Mean arterial blood pressure increased significantly from 54 +/- 3 to 72 +/- 5 mmHg 10 min after terlipressin administration (P = 0.001). Heart rate decreased from 153.0 +/- 6.5 beats/min to 138.0 +/- 7.5 beats/min 12 h after treatment onset (P = 0.003). Epinephrine infusion was decreased or stopped in eight patients after terlipressin administration. Urine output increased from 1.6 +/- 0.5 mL/kg/h to 4.3 +/- 1.2 mL/kg/h 1 h after treatment onset (P = 0.011). PaO2 increased from 95.1 +/- 12.3 mmHg to 110.1 +/- 20.5 mmHg, and the oxygenation index decreased from 10.2 +/- 2.2 to 9.2 +/- 1.7. Terlipressin treatment of hypotension due to septic shock was successful in eight out of 16 episodes. Six of the 14 patients with poor prognosis for survival recovered. We conclude that terlipressin improves hemodynamic indices and renal function in critically ill children. Terlipressin should be considered as a rescue therapy in intractable shock not responsive to catecholamines in children.
authors.affiliation: Department of Pharmacy Services, Safra Children's Hospital, The Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Ilan
authors.initials: I
authors.lastname: Matok
authors.forename: Amir
authors.initials: A
authors.lastname: Vard
authors.forename: Ori
authors.initials: O
authors.lastname: Efrati
authors.forename: Marina
authors.initials: M
authors.lastname: Rubinshtein
authors.forename: Tali
authors.initials: T
authors.lastname: Vishne
authors.forename: Leah
authors.initials: L
authors.lastname: Leibovitch
authors.forename: Miriam
authors.initials: M
authors.lastname: Adam
authors.forename: Zohar
authors.initials: Z
authors.lastname: Barzilay
authors.forename: Gideon
authors.initials: G
authors.lastname: Paret
mesh_terms: D000293:Adolescent; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002395:Catecholamines / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D004837:Epinephrine / Q000494:pharmacology; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007022:Hypotension / Q000188:drug therapy*; D007223:Infant; D007231:Infant, Newborn; D008236:Lypressin / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D008297:Male; D010100:Oxygen / Q000737:chemistry / Q000378:metabolism; D011379:Prognosis; D012772:Shock, Septic / Q000150:complications* / Q000188:drug therapy*; D000077585:Terlipressin; D013997:Time Factors
chemical_list: D000959:Antihypertensive Agents; D002395:Catecholamines; D008236:Lypressin; D000077585:Terlipressin; D003404:Creatinine; D010100:Oxygen; D004837:Epinephrine