Therapeutic applications of vasopressin in pediatric patients
Amit Agrawal1, Vishal K Singh, Amit Varma
1Departments of Pediatrics, Chirayu Medical College and Hospital, Bhopal, MP, India. agrawaldramit@yahoo.co.in
Insights
Vasopressin therapy shows promise for critically ill children with refractory shock and cardiac arrest, improving blood pressure and reducing catecholamine needs. However, high mortality rates persist, necessitating further research for definitive recommendations.
Area of Science:
- Pediatric Critical Care Medicine
- Pediatric Pharmacology
- Pediatric Resuscitation
Background:
- Vasopressin therapy is emerging as a significant advancement in managing critically ill children experiencing shock and cardiac arrest.
- Previous reports highlight successful vasopressin use in diverse shock states, prompting further investigation into its pediatric applications.
Purpose of the Study:
- To comprehensively review the physiology of vasopressin and its rationale for use in pediatric patients.
- To outline dose schedules for vasopressin in various pediatric disease states.
- To focus on recent therapeutic advancements and applications of vasopressin in pediatric critical care.
Main Methods:
- A systematic MEDLINE search (1966-September 2011) was conducted using relevant keywords for pediatric vasopressin/terlipressin studies.
- Included were human studies such as randomized controlled trials, cohort studies, case series, and case reports involving children aged 0-21 years.
- Outcomes analyzed included indication, dosage, duration, effects on blood pressure, catecholamine requirements, urine output, lactate levels, adverse events, and mortality.
Main Results:
- 51 reports detailing vasopressin (30) and terlipressin (21) use in 602 pediatric patients were identified across septic shock, post-cardiotomy shock, other vasodilatory shock, and cardiac arrest.
- Commonly observed responses included rapid improvements in systemic blood pressure, decreased need for concurrent catecholamines, and increased urine output.
- Despite positive hemodynamic effects, overall mortality rates in the studied pediatric population remained high.
Conclusions:
- Limited clinical experience and a paucity of randomized controlled trials in pediatrics preclude definitive recommendations for vasopressin/terlipressin use.
- Current clinical data suggests vasopressin can be utilized as a rescue therapy for refractory shock and cardiac arrest in critically ill children.
- Further research is warranted to establish clear guidelines and optimize the use of vasopressin in pediatric critical care settings.
Context:
Reports of successful use of vasopressin in various shock states and cardiac arrest has lead to the emergence of vasopressin therapy as a potentially major advancement in the management of critically ill children.
Objective:
To provide an overview of physiology of vasopressin, rationale of its use and dose schedule in different disease states with special focus on recent advances in the therapeutic applications of vasopressin.
Data Source:
MEDLINE search (1966-September 2011) using terms vasopressin, terlipressin, arginine-vasopressin, shock, septic shock, vasodilatory shock, cardiac arrest, and resuscitation for reports on vasopressin/terlipressin use in children and manual review of article bibliographies. Search was restricted to human studies. Randomized controlled trials, cohort studies, evaluation studies, case series, and case reports on vasopressin/terlipressin use in children (preterm neonates to 21 years of age) were included. Outcome measures were analysed using following clinical questions: indication, dose and duration of vasopressin/terlipressin use, main effects especially on systemic blood pressure, catecholamine requirement, urine output, serum lactate, adverse effects, and mortality.
Results:
51 reports on vasopressin (30 reports) and terlipressin (21 reports) use in pediatric population were identified. A total of 602 patients received vasopressin/terlipressin as vasopressors in various catecholamine-resistant states (septic - 176, post-cardiotomy - 136, other vasodilatory/mixed shock - 199, and cardiac arrest - 101). Commonly reported responses include rapid improvement in systemic blood pressure, decline in concurrent catecholamine requirement, and increase in urine output; despite these effects, the mortality rates remained high.
Conclusion:
In view of the limited clinical experience, and paucity of randomized controlled trials evaluating these drugs in pediatric population, currently no definitive recommendations on vasopressin/terlipressin use can be laid down. Nevertheless, available clinical data supports the use of vasopressin in critically ill children as a rescue therapy in refractory shock and cardiac arrest.
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