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Vasopressin in the treatment of vasodilatory shock in children
Satoshi Masutani1, Hideaki Senzaki, Hirotaka Ishido
1Department of Pediatric Cardiology and Cardiovascular Surgery, Saitama Heart Institute, Saitama Medical School Hospital, Saitama, Japan.
Insights
Vasopressin deficiency can cause catecholamine-resistant hypotension in children. Administering vasopressin (a hormone) effectively improved blood pressure and urinary output in pediatric patients with this condition.
Area of Science:
- Pediatric critical care medicine
- Endocrinology
- Pharmacology
Background:
- Vasopressin deficiency is a recognized cause of catecholamine-resistant hypotension in adults.
- Limited data exists regarding vasopressin deficiency in pediatric patients.
- Understanding this deficiency is crucial for managing pediatric shock.
Purpose of the Study:
- To evaluate the efficacy of vasopressin administration in pediatric patients experiencing catecholamine-resistant hypotension.
- To analyze the impact of vasopressin on urinary output and blood pressure in this population.
Main Methods:
- Retrospective analysis of 12 pediatric patients (15 instances) treated with vasopressin for hypotension.
- Causes of vasodilation included central nervous system disturbance, drug side-effects, and infection.
- Plasma vasopressin levels were measured before and during vasopressin administration.
Main Results:
- Patients were grouped based on response to vasopressin, with significant improvements in urinary output and/or blood pressure observed.
- Low baseline plasma vasopressin concentrations were noted in hypotensive patients.
- Vasopressin administration significantly increased plasma vasopressin levels.
- No significant side-effects were reported.
Conclusions:
- Vasopressin deficiency is a potential cause of catecholamine-resistant hypotension in children due to various underlying conditions.
- Low-dose vasopressin administration appears effective in improving hemodynamic status and urinary output in pediatric patients.
- Further research is warranted to establish optimal dosing and indications.
Background:
Many recent studies suggest that vasopressin deficiency is an important cause of catecholamine-resistant hypotension with vasodilation in adults, but little is known about vasopressin deficiency in children.
Methods:
To clarify the usefulness of vasopressin administration in pediatric cathecolamine-resistant hypotension with preserved ventricular contractility, urinary output and blood pressure response to vasopressin were retrospectively analyzed in 12 consecutive patients (15 instances) who were treated with vasopressin. The causes of vasodilation were central nervous system disturbance (n = 5), side-effect of drug (n = 5), and infection (n = 5). Plasma vasopressin concentration was measured six times before vasopressin administration and five times during vasopressin administration.
Results:
Patients were divided into four groups according to their response to vasopressin administration. In group 1 (n = 5), urinary output increased to > 3 mL/kg per h within 3 h after vasopressin administration. In group 2 (n = 4), urinary output increased to > 3 mL/kg per h from 3 to 5 h after vasopressin administration. In group 3 (n = 4), urinary output did not increase to > 3 mL/kg per min within 5 h after vasopressin administration, but systolic blood pressure increased to > 120% of the level at the time of vasopressin administration. All remaining patients were classified into group 4 (n = 3). Plasma vasopressin concentration were low considering the markedly hypotensive state in all six instances. Plasma vasopressin concentration during vasopressin administration were significantly increased compared with before administration (P < 0.05). No apparent side-effects were observed in this series.
Conclusion:
Vasopressin deficiency may occur in catecholamine-resistant hypotension of pediatric patients due to various causes including central nervous system disturbance, drug induced hypotension and sepsis. Small doses of vasopressin administration seems to be very effective in such conditions by increasing blood pressure and urinary output.
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