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

Abstract

Although terlipressin infusion had no effect on mortality, it significantly increases mean arterial pressure, PaO2/FIO2, and survival time in nonsurvivors. Terlipressin seems to cause no adverse effect but warrants further evaluation as a rescue therapy in refractory septic shock.

The role of vasopressin and terlipressin in catecholamine-resistant shock and cardio-circulatory arrest in children: Review of the literature

“…1). Only 6 reports were done prospectively [11,14,23,31,34,39], while 13 were retrospective reports [12, 18, 24-29, 32, 35, 36, 40, 41]. In the remaining 12 reports the nature of the study was not clarified.…”

“…The age ranged from extremely low birthweight infants [29,34] up to a 19-year-old patient. Sixteen articles were descriptive case series [14, 17, 18, 22, 24, 26-29, 34-38, 40, 41], 10 reports were case reports [12, 13, 15, 16, 19-21, 25, 30, 33], three were clinical evaluation studies [23,32,39], one study was a non-blind randomised control trial [11] and one was a multicentre double-blind randomised control trial [31]. Eighteen reports used AVP while thirteen did TP (Tab.…”

“…In most reports, AVP and TP were exclusively used as a rescue therapy in severe forms of septic, cardiogenic, anaphylactic and hypotensive shock that was not responsive to catecholamines. Twelve reports were confined solely to septic patients [11][12][13][14][15][16][17][18][19][20][21][22], 6 reports were solely on patients with low cardiac output and/or concomitant severe vasodilation following cardiac surgery in some patients [23][24][25][26][27][28], 10 included a heterogenous population (septic shock, cardio-circulatory failure secondary to congenital heart disease, haemorrhagic and anaphylactic) [29][30][31][32][33][34][35][36][37][38] (for more details regarding septic vs. cardiac shock please see below). TP and AVP were used for cardiopulmonary resuscitation in three articles [39][40][41].…”

“…Sixteen case series and three clinical evaluation studies [14, 17, 18, 22-24, 26-29, 32, 34-39, 40, 41] included in this study fulfilled the criteria for level 4 studies as laid out by the Oxford Centre for Evidencebased Medicine Levels of Evidence [8]; one study was a non-blind randomised controlled study (level 1c) [11], and only one study was a multicentre double-blind randomised controlled study (level 1b) [31].…”

Year in review in Intensive Care Medicine, 2008: III. Paediatrics, Ethics, outcome research and critical care organization, sedation, pharmacology and miscellanea

“…Haemodynamics appear to have been favourably influenced, but the authors noted adverse effects on renal function and lower platelet counts associated with vasopressin use. Yildizdas et al [9] performed a randomised non-blinded comparison of the use of the vasopressin analogue terlipressin in a group of 58 children with refractory septic shock. Although terlipressin had no beneficial effect on mortality rate in this study, its use was associated with increased mean arterial pressure, improved oxygenation, decreased length of stay in the PICU and had a beneficial effect on survival time among nonsurvivors.…”