Vasopressin in pediatric shock and cardiac arrest.
OBJECTIVE
To review the physiology and the published literature on the role of vasopressin in shock in children.


METHODS
We searched MEDLINE (1966-2007), EMBASE (1980-2007), and the Cochrane Library, using the terms vasopressin, terlipressin, and shock and synonyms or related terms for relevant studies in pediatrics. We searched the online ISRCTN-Current Controlled Trials registry for ongoing trials. We reviewed the reference lists of all identified studies and reviews as well as personal files to identify other published studies.


RESULTS
Beneficial effects have been reported in vasodilatory shock and asystolic cardiac arrest in adults. Solid evidence for vasopressin use in children is scant. Observational studies have reported an improvement in blood pressure and rapid weaning off catecholamines during administration of low-dose vasopressin. Dosing in children is extrapolated from adult studies.


CONCLUSIONS
Vasopressin offers promise in shock and cardiac arrest in children. However, in view of the limited experience with vasopressin, it should be used with caution. Results of a double-blind, randomized controlled trial in children with vasodilatory shock will be available soon.
Choong
Karen
K
Pediatric Critical Care and Neonatology, McMaster Children's Hospital, Hamilton, Ontario, Canada. choongk@mcmaster.ca
Kissoon
Niranjan
N
D000818:Animals; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D002648:Child; D002986:Clinical Trials as Topic; D016638:Critical Illness; D006323:Heart Arrest / Q000378:metabolism / Q000628:therapy*; D006801:Humans; D012769:Shock / Q000188:drug therapy* / Q000378:metabolism; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D014667:Vasopressins / Q000502:physiology* / Q000627:therapeutic use
D014662:Vasoconstrictor Agents; D014667:Vasopressins