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

Meyer, Sascha; McGuire, William; Gottschling, Sven; Shamdeen, G; Gortner, Ludwig

doi:10.1007/s10354-010-0853-7

Cited by 17 publications

(8 citation statements)

References 60 publications

(224 reference statements)

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“…Thereafter, hemodynamic support is achieved with vasopressors and inotropes [5, 7]. However, reduced vasoconstrictor sensitivity to vasopressors in shock can lead to vasodilation, severe hypotension, and vasoparalysis [8]. There is, therefore, a pressing need for agents which target other pathways involved in the development of shock.…”

Section: Introductionmentioning

confidence: 99%

“…AVP acts on V1 receptors located on vascular smooth muscle leading to an increase in mean arterial pressure (MAP). Patients with shock exhibit inappropriately low circulating AVP concentrations [7, 8, 10]. From a biologic perspective, the basic rationale behind the addition of AVP/TP in refractory shock is the depletion of endovascular AVP in states of shock [11].…”

Section: Introductionmentioning

confidence: 99%

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Role of vasopressin and terlipressin in refractory shock compared to conventional therapy in the neonatal and pediatric population: a systematic review, meta-analysis, and trial sequential analysis

et al. 2017

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BackgroundVasopressin (AVP) and terlipressin (TP) have been used as last-line therapy in refractory shock in children. However, the efficacy and safety profiles of AVP and TP have not been determined in pediatric refractory shock of different origins. We aimed to assess the efficacy and safety of the addition of AVP/TP therapy in pediatric refractory shock of all causes compared to conventional therapy with fluid resuscitation and vasopressor and inotropic therapy.MethodsWe conducted a systematic review, meta-analysis, and trial sequential analysis (TSA) comparing AVP and TP to conventional therapy. MEDLINE, EMBASE, Cochrane Library, and ClinicalTrials.gov were searched up to February 2016. The systematic review included all reports of AVP/TP use in the pediatric population. Reports of clinical trials were pooled using random-effects models and TSA. Main outcomes were mortality and tissue ischemia.ResultsThree randomized controlled trials and five “before-and-after clinical” trials (without comparator) met the inclusion criteria. Among 224 neonates and children (aged 0 to 18 years) with refractory shock, 152 received therapy with AVP or TP. Pooled analyses showed no association between AVP/TP treatment and mortality (relative risk (RR),1.19; 95% confidence interval (CI), 0.71–2.00), length of stay in the pediatric intensive care unit (PICU) (mean difference (MD), –3.58 days; 95% CI, –9.05 to 1.83), and tissue ischemia (RR, 1.48; 95% CI, 0.47–4.62). In TSA, no significant effect on mortality and risk for developing tissue ischemia was observed with AVP/TP therapy.ConclusionOur results emphasize the lack of observed benefit for AVP/TP in terms of mortality and length of stay in the PICU, and suggest an increased risk for ischemic events. Our TSA suggests that further large studies are necessary to demonstrate and establish benefits of AVP/TP in children.PROSPERO registry: CRD42016035872Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1589-6) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Role of vasopressin and terlipressin in refractory shock compared to conventional therapy in the neonatal and pediatric population: a systematic review, meta-analysis, and trial sequential analysis

et al. 2017

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“…Experience with AVP/TP in neonates has been more focused on term newborns with congenital heart disease who develop hypotension after surgery, newborns with PPHN or with septic shock all reporting increased blood pressure, most reporting increased urine output and some reporting decreased lactate levels coming from retrospective studies or case series [85,[90][91][92][93][94][95].…”

Section: Evidence and Pd Effectsmentioning

confidence: 99%

Cardiovascular Drug Therapy for Human Newborn: Review of Pharmacodynamic Data

Ergenekon

Rojas-Anaya

Bravo

et al. 2018

CPD

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Background: Circulatory failure in preterm and term newborn infants is commonly treated with inotropes or vasoactive medications. In this structured literature review the available data on pharmacodynamic effects of the inotropes adrenaline, dobutamine, dopamine, levosimendan, milrinone, noradrenaline, and the vasoactive drugs vasopressin and hydrocortisone are presented. Methods: Structured searches were conducted to identify relevant articles according to pre-defined inclusion criteria which were human clinical trials published after 2000.Results: Out of 101 identified eligible studies only 22 studies met the criteria for evidence based practice guidelines level I to IV. The most prevalent pharmacodynamic effects were increase in blood pressure and/or heart rate, which were also the most frequently studied circulatory parameters. Conclusion: This review demonstrates the need for further systematic studies on all reviewed drugs with incorporation of novel noninvasive biomarkers in this vulnerable patient group, for more timely and appropriate treatment for clinical efficacy.

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“…31 The postulated mechanism of action for this effect is that the stimulation of V1 receptors in vascular smooth muscle leads to an increase in cytoplasmic ionized calcium via the phosphatidylinositol biphosphate cascade. [31][32][33] In HRS type 1, the effect that terlipressin promulgates is mediated by vasoconstriction of the splanchnic arterial blood vessels reducing blood flow to the system, thereby providing indirect volume expansion. 3 Stimulation of V2 receptors responsible for an antidiuretic effect is less desirable in HRS.…”

Section: Discussionmentioning

confidence: 99%

A randomized, placebo-controlled, double-blind study to confirm the reversal of hepatorenal syndrome type 1 with terlipressin: the REVERSE trial design

Boyer¹,

Medicis²,

Pappas³

et al. 2012

OAJCT

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

Abstract: No firm recommendations on the use of AVP/TP in children with severe forms of cardio-circulatory failure can be issued.

Cited by 17 publications

References 60 publications

Role of vasopressin and terlipressin in refractory shock compared to conventional therapy in the neonatal and pediatric population: a systematic review, meta-analysis, and trial sequential analysis

Role of vasopressin and terlipressin in refractory shock compared to conventional therapy in the neonatal and pediatric population: a systematic review, meta-analysis, and trial sequential analysis

Cardiovascular Drug Therapy for Human Newborn: Review of Pharmacodynamic Data

A randomized, placebo-controlled, double-blind study to confirm the reversal of hepatorenal syndrome type 1 with terlipressin: the REVERSE trial design

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