Terlipressin as a rescue therapy for catecholamine-resistant septic shock in children.
OBJECTIVE
To evaluate the effect of terlipressin on oxygenation, PaO2/FIO2, heart rate, mean arterial pressure, and mortality in children with septic shock refractory to high doses of dopamine/dobutamine and adrenaline.


METHODS
A randomized, nonblind study in the pediatric intensive care unit of a university hospital.


METHODS
We studied 58 children with septic shock and refractory hypotension despite fluid loading and high doses of catecholamines, randomly enrolled to terlipressin (TP, n=30) or control (n=28). TP was administered as intravenous bolus doses of 20 microg/kg every 6 h for a maximum of 96 h. Hemodynamic changes, PaO2/FIO2 rates, length of stay, and mortality rate in PICU were recorded prospectively.


RESULTS
Mean arterial pressure and PaO2/FIO2 significantly increased, and heart rate significantly decreased 30 min after each TP treatment, but mortality did not differ from control (67.3% vs. 71.4%). Mean stay in the PICU was shorter in the TP group (13.4+/-7.9 vs. 20.2+/-9.7 days and was longer among nonsurvivors of the TP group vs. control (10.4+/-6.9 vs. 6.2+/-3.4 days). Blood urea nitrogen, creatinine, AST, ALT, and urine output of patients in the TP group did not change after terlipressin.


CONCLUSIONS
Although terlipressin infusion had no effect on mortality, it significantly increases mean arterial pressure, PaO2/FIO2, and survival time in nonsurvivors. Terlipressin seems to cause no adverse effect but warrants further evaluation as a rescue therapy in refractory septic shock.
Yildizdas
Dincer
D
Faculty of Medicine, Department of Pediatrics, Division of Intensive Care Unit, Cukurova University, 01330 Balcali, Adana, Turkey. dyildizdas@cu.edu.tr
Yapicioglu
Hacer
H
Celik
Umit
U
Sertdemir
Yasar
Y
Alhan
Emre
E
D000293:Adolescent; D001794:Blood Pressure / Q000187:drug effects; D002395:Catecholamines / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004351:Drug Resistance; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007022:Hypotension / Q000097:blood / Q000188:drug therapy; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D008236:Lypressin / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008297:Male; D010100:Oxygen / Q000097:blood; D011446:Prospective Studies; D012772:Shock, Septic / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D000077585:Terlipressin; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D002395:Catecholamines; D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin; D010100:Oxygen