Continuous Hemodynamic Response to Angiotensin II in Critically Ill Pediatric Patients: A Single Center Cohort Study

To report efficacy, safety, and dosing of angiotensin II (AT-II) in pediatric patients with refractory vasodilatory shock.

This was a single center retrospective cohort study using automated, high-fidelity hemodynamic data in a large tertiary pediatric academic medical center. Pediatric patients who required multimodal vasopressor therapy for fluid refractory vasodilatory shock and received AT-II between June 2017 and November 2022 were included. High-fidelity hemodynamic data were captured via the Etiometry T3 platform. Vasoactive-inotropic score (VIS), AT-II dosing, demographics, clinical characteristics, and potential adverse effects were collected from the electronic medical record.

Fourteen pediatric patients with a median age of 11.6 years (range, 13 days-16.8 years) received AT-II at a dose of 2.5 to 80 ng/kg/min for a median of 32 hours (range, 3.1-72.4). Ten of 14 patients (71%) responded favorably to AT-II therapy, experiencing a clinically significant decrease in VIS or increase in mean arterial blood pressure. The median age of responders was significantly higher than that of nonresponders (12.5 years vs 0.4 years; p = 0.002), and responders had a higher baseline VIS (56 vs 33; p = 0.008) than nonresponders. One patient (7%) experienced peripheral ischemia.

Angiotensin II has a potential role in the management of pediatric patients with vasodilatory shock resistant to multimodal vasopressor therapy. Demographic and clinical characteristics predicting response in the pediatric population require careful, prospective evaluation.