Terlipressin as a rescue therapy for catecholamine-resistant septic shock in children

• Published in: Intensive care medicine 2008-03, Vol.34 (3), p.511-517
• Main Authors: Yildizdas, Dincer, Yapicioglu, Hacer, Celik, Umit, Sertdemir, Yasar, Alhan, Emre
• Format: Article
• Language: English
• Subjects: Adolescent; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology; Biological and medical sciences; Blood pressure; Blood Pressure - drug effects; Catecholamines; Catecholamines - therapeutic use; Child; Child, Preschool; Critical Care Medicine; Disease; Dopamine; Drug dosages; Drug Resistance; Emergency and intensive care: infection, septic shock; Emergency Medicine; Female; Heart rate; Heart Rate - drug effects; Hemodynamics; Humans; Hypotension; Hypotension - blood; Hypotension - drug therapy; Hypoxia; Intensive; Intensive care; Intensive care medicine; Intensive Care Units, Pediatric; Length of Stay; Lypressin - analogs & derivatives; Lypressin - therapeutic use; Male; Medical sciences; Medicine; Medicine & Public Health; Mortality; Nitric oxide; Organisms; Oxygen - blood; Oxygen saturation; Pain Medicine; Pediatric Original; Pediatrics; Pneumology/Respiratory System; Prospective Studies; Pulmonary arteries; Sepsis; Shock, Septic - blood; Shock, Septic - drug therapy; Shock, Septic - physiopathology; Smooth muscle; Treatment Outcome; Vasoconstrictor Agents - therapeutic use
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-007-0971-x

Objective To evaluate the effect of terlipressin on oxygenation, PaO 2 /FIO 2 , heart rate, mean arterial pressure, and mortality in children with septic shock refractory to high doses of dopamine/dobutamine and adrenaline. Design and setting A randomized, nonblind study in the pediatric intensive care unit of a university hospital. Patients and measurements 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 μg/kg every 6 h for a maximum of 96 h. Hemodynamic changes, PaO 2 /FIO 2 rates, length of stay, and mortality rate in PICU were recorded prospectively. Results Mean arterial pressure and PaO 2 /FIO 2 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, PaO 2 /FIO 2 , and survival time in nonsurvivors. Terlipressin seems to cause no adverse effect but warrants further evaluation as a rescue therapy in refractory septic shock.