Vasopressin in catecholamine-refractory shock in children.
Severe septic and cardiogenic shock is associated with a high mortality in neonates, children and adolescents. Common therapies include the administration of fluids and the use of conventional inotropes. However, in severe forms of shock, cardio-circulatory failure may be secondary to profound vasoparalysis and unresponsive to conventional therapies. We reviewed the literature on the use of arginine-vasopressin (AVP) and terlipressin (TP) as a rescue therapy in neonates, children and adolescents with catecholamine-refractory shock or cardio-circulatory arrest. We identified 17 reports (11 case series, 6 case reports) on a total of 109 patients. Only two studies were prospective. The age of treated patients ranged from extremely low birth weight infants of 23 weeks' gestation to a 19-year-old adolescent. The most common indication for either drug was catecholamine-refractory septic shock (nine reports). Commonly reported responses following AVP/TP administration were a rapid increase in systemic arterial blood pressure, an increase in urine output, and a decrease in serum lactate. In most reports, AVP and TP had a significant impact on the required dose of inotropes which could be reduced. Despite the use of AVP/TP, mortality was high (52/109). In view of the limited number of paediatric patients treated with AVP/TP, no definite recommendations on their use in children with severe forms of cardio-circulatory failure can be issued. There is a need for larger prospective trials assessing the efficacy and safety profiles of these drugs in a defined setting. Until more data are available, and taking into consideration the detrimental impact catecholamine-refractory shock has on children, the use of AVP/TP as a rescue therapy should be considered on an individual basis.
Meyer
S
S
Australian National University, Medical School, The Centre for Newborn Care, Canberra, Australia. sascha.meyer@uniklinik-saarland.de
Gortner
L
L
McGuire
W
W
Baghai
A
A
Gottschling
S
S
D000293:Adolescent; D000328:Adult; D001127:Arginine Vasopressin / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002395:Catecholamines / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019344:Lactic Acid / Q000097:blood; D008236:Lypressin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D012769:Shock / Q000097:blood / Q000188:drug therapy*; D000077585:Terlipressin; D017211:Treatment Failure; D014556:Urine; D014662:Vasoconstrictor Agents / Q000009:adverse effects / Q000627:therapeutic use*
D002395:Catecholamines; D014662:Vasoconstrictor Agents; D001127:Arginine Vasopressin; D019344:Lactic Acid; D008236:Lypressin; D000077585:Terlipressin