Vasopressin in catecholamine-refractory shock in children

Area of Science:

• Pediatric Critical Care Medicine
• Pharmacology
• Cardiovascular Research

Background:

• Severe septic and cardiogenic shock in neonates, children, and adolescents carry high mortality rates.
• Conventional therapies like fluids and inotropes may be insufficient for profound vasoparalysis.
• Arginine-vasopressin (AVP) and terlipressin (TP) are explored as rescue agents.

Purpose of the Study:

• To review the literature on AVP and TP use in pediatric catecholamine-refractory shock or cardio-circulatory arrest.
• To assess the efficacy and safety of AVP/TP as rescue therapy in this population.

Main Methods:

• Literature review of 17 reports (11 case series, 6 case reports) involving 109 pediatric patients.
• Analysis of patient age, indications for AVP/TP, and reported outcomes.
• Focus on patients with catecholamine-refractory shock or cardio-circulatory arrest.

Main Results:

• AVP/TP administration led to increased systemic arterial blood pressure, urine output, and decreased serum lactate.
• These agents allowed for a reduction in the required dose of conventional inotropes.
• Despite AVP/TP use, overall mortality remained high at 52% (52/109 patients).

Conclusions:

• AVP and TP demonstrate potential as rescue therapies for severe pediatric shock, improving hemodynamic parameters.
• Limited data and high mortality underscore the need for larger, prospective pediatric trials.
• Current use should be individualized, considering the critical condition of patients with catecholamine-refractory shock.