title: Terlipressin in the treatment of late phase catecholamine-resistant septic shock.
abstract: OBJECTIVE
  Norepinephrine, but also dopamine and epinephrine are recommended as first line vasopressors in the treatment of septic shock. In some patients, septic shock deteriorates and becomes to be resistant to catecholamines. In this situation, addition of vasopressin or terlipressin can be advantageous. The aim of our pilot study was to evaluate the impact of terlipressin on open label norepinephrine requirements and mortality.
  
  
  METHODS
  In a randomized, controlled, single centre study we assigned patients with late advanced septic shock refractory to catecholamines (norepinephrine >0.6µg/kg/min for more than 24h) to receive either continuously terlipressin 4mg/24h for 72 hours in addition to open label norepinephrine (TERLI group) or to continue therapy only with catecholamines (CON group). All vasopressor infusions were titrated to maintain a target blood pressure.
  
  
  RESULTS
  We enrolled 30 patients, of whom 13 were assigned to terlipressin and in 17 we continued in catecholamine therapy. There was no significant difference in norepinephrine consumption between the groups. Open label norepinephrine infusion rates decreased significantly in the TERLI group as compared with initial consumption, but the decrease we observed only in 7 (54%) patients. There was no significant difference between groups in the rate of death at day 28 (77% in TERLI group and 94% in CON group; p=0.18) or at day 90 (91% vs. 94%; p=0.85).
  
  
  CONCLUSIONS
  Continuous terlipressin infusion was not effective in reducing norepinephrine consumption or in the mortality of patients, if administered in late phase of catecholamine refractory septic shock.
authors.affiliation: Trauma Hospital Brno, Research Center for Traumatology and Surgery, Brno, Czech Republic. p.svoboda@unbr.cz
authors.forename: Petr
authors.initials: P
authors.lastname: Svoboda
authors.forename: Peter
authors.initials: P
authors.lastname: Scheer
authors.forename: Ilona
authors.initials: I
authors.lastname: Kantorová
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Doubek
authors.forename: Jan
authors.initials: J
authors.lastname: Dudra
authors.forename: Martin
authors.initials: M
authors.lastname: Radvan
authors.forename: Jana
authors.initials: J
authors.lastname: Radvanova
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004351:Drug Resistance; D005260:Female; D006801:Humans; D008236:Lypressin / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000627:therapeutic use*; D012772:Shock, Septic / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D000077585:Terlipressin; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin; D009638:Norepinephrine