The role of vasopressin and terlipressin in catecholamine-resistant shock and cardio-circulatory arrest in children: review of the literature.
BACKGROUND
Arginine-vasopressin (AVP) and terlipressin (TP) are used as rescue drugs for states of shock and cardio-circulatory failure.


METHODS
Review to assess AVP/TP as a rescue therapy in children with catecholamine-resistant shock or cardio-circulatory arrest.


RESULTS
A total of 31 reports were included (428 patients); sixteen articles were case series, 10 case reports, 3 clinical evaluation studies, one study was a non-blind RCT while one study was a multicentre double-blind RCT. The most common indication for either drug was catecholamine-refractory septic shock (12 reports). Commonly reported responses following AVP/TP administration were a rapid increase in blood pressure, an increase in urine output, and a decrease in serum lactate. In most reports, AVP and TP led to the reduction of catecholamines. The cumulative mortality rate remained high (188/428; 43.9%) despite the use of AVP/TP.


CONCLUSIONS
No firm recommendations on the use of AVP/TP in children with severe forms of cardio-circulatory failure can be issued.
Department of Paediatrics and Paediatic Intensive Care Medicine, University Hospital of Saarland, Homburg, Germany. sascha.meyer@uniklinik-saarland.de
Sascha
S
Meyer
William
W
McGuire
Sven
S
Gottschling
Ghiath
G
Mohammed Shamdeen
Ludwig
L
Gortner
D000293:Adolescent; D001127:Arginine Vasopressin / Q000009:adverse effects / Q000627:therapeutic use*; D002303:Cardiac Output, Low / Q000188:drug therapy / Q000401:mortality; D016887:Cardiopulmonary Resuscitation; D002395:Catecholamines / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004351:Drug Resistance; D005260:Female; D006323:Heart Arrest / Q000188:drug therapy* / Q000401:mortality; D006439:Hemodynamics / Q000187:drug effects; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000188:drug therapy / Q000401:mortality; D008236:Lypressin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008297:Male; D016032:Randomized Controlled Trials as Topic; D012770:Shock, Cardiogenic / Q000188:drug therapy* / Q000401:mortality; D012772:Shock, Septic / Q000188:drug therapy* / Q000401:mortality; D015996:Survival Rate; D000077585:Terlipressin; D055815:Young Adult
D002395:Catecholamines; D001127:Arginine Vasopressin; D008236:Lypressin; D000077585:Terlipressin
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