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Terlipressin for catecholamine-resistant septic shock in children
Antonio Rodríguez-Núñez1, Manuel Fernández-Sanmartín, Federico Martinón-Torres
1Pediatric Emergency and Critical Care Division, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain, Antonio.Rodriguez.Nunez@sergas.es
Insights
Terlipressin effectively treated septic shock in children when standard catecholamines failed. This vasopressor demonstrated rapid, sustained blood pressure improvement with no adverse effects observed in these pediatric cases.
Area of Science:
- Pediatric Critical Care Medicine
- Pharmacology
- Septic Shock Management
Background:
- Septic shock in children often presents with hypotension refractory to catecholamine vasopressors.
- Identifying effective rescue therapies for pediatric septic shock is crucial for improving outcomes.
Observation:
- This case report details the use of terlipressin in four pediatric patients with severe septic shock and catecholamine-resistant hypotension.
- Terlipressin was administered intravenously as a bolus at 0.02 mg/kg every 4 hours for up to 3 days.
Findings:
- Terlipressin rapidly and sustainably improved mean arterial pressure in all four patients.
- Norepinephrine infusions were reduced or discontinued in patients receiving terlipressin.
- No adverse effects related to terlipressin administration were observed.
Implications:
- Terlipressin shows promise as a rescue therapy for pediatric septic shock unresponsive to catecholamines.
- Further research is warranted to confirm these findings and determine optimal dosing and administration schedules.
- This study highlights a potential new treatment option for refractory hypotension in pediatric septic shock.
Objective:
To report the effects of terlipressin treatment in four paediatric patients with catecholamine-resistant hypotensive septic shock.
Design And Setting:
Case report in the pediatric intensive care unit of a university hospital.
Patients:
Four children with severe septic shock and hypotension resistant to high doses of norepinephrine and other cathecolamines.
Interventions:
Terlipressin was added to the standard treatment, by intravenous bolus at a dose of 0.02 mg/kg every 4 h during a maximum time of 3 days.
Measurement And Results:
In all cases, terlipressin induced a rapid and sustained improvement in mean arterial pressure, which allowed the lessening or even withdrawal of norepinephrine infusion. No related adverse effects were detected.
Conclusion:
Terlipressin might be considered, at least as a rescue therapy, for hypotension resistant to catecholamines in children with septic shock. Further studies are needed to confirm the beneficial effects found in our patients. The optimal administration schedule remains to be elucidated.
