Terlipressin as rescue therapy for intractable hypotension due to septic shock in children. Shock (Augusta, Ga.) [Shock] Journal article | | Title | Terlipressin as rescue therapy for intractable hypotension due to septic shock in children. | | Author(s) | Matok I, Vard A, Efrati O, Rubinshtein M, Vishne T, Leibovitch L, Adam M, Barzilay Z, Paret G | | Institution | Department of Pharmacy Services, Safra Children's Hospital, The Chaim Sheba Medical Center, Tel Hashomer, Israel. | | Source | Shock 2005 Apr; 23(4):305-10. | | MeSH | Adolescent
Antihypertensive Agents
Blood Pressure
Catecholamines
Child
Child, Preschool
Creatinine
Epinephrine
Female
Heart Rate
Humans
Hypotension
Infant
Infant, Newborn
Lypressin
Male
Oxygen
Prognosis
Shock, Septic
Time Factors
| | Abstract | Intractable hypotension due to septic shock is associated with high mortality rates in critically ill children worldwide. The use of terlipressin (triglycyl-lysine-vasopressin), an analog of vasopressin with a longer duration of action, recently emerged as a treatment of hypotension not responsive to vasopressors and inotropes. This was a retrospective study set in an 18-bed pediatric critical care department in a tertiary care children's hospital. We reviewed the files of all children with septic shock who were treated with terlipressin between January 2003 and February 2004. Fourteen children (mean age, 5.6 years; range, 4 days to 17.7 years) were treated with terlipressin in 16 septic shock episodes. Significant improvements in respiratory and hemodynamic indices were noted shortly after treatment. Mean arterial blood pressure increased significantly from 54 +/- 3 to 72 +/- 5 mmHg 10 min after terlipressin administration (P = 0.001). Heart rate decreased from 153.0 +/- 6.5 beats/min to 138.0 +/- 7.5 beats/min 12 h after treatment onset (P = 0.003). Epinephrine infusion was decreased or stopped in eight patients after terlipressin administration. Urine output increased from 1.6 +/- 0.5 mL/kg/h to 4.3 +/- 1.2 mL/kg/h 1 h after treatment onset (P = 0.011). PaO2 increased from 95.1 +/- 12.3 mmHg to 110.1 +/- 20.5 mmHg, and the oxygenation index decreased from 10.2 +/- 2.2 to 9.2 +/- 1.7. Terlipressin treatment of hypotension due to septic shock was successful in eight out of 16 episodes. Six of the 14 patients with poor prognosis for survival recovered. We conclude that terlipressin improves hemodynamic indices and renal function in critically ill children. Terlipressin should be considered as a rescue therapy in intractable shock not responsive to catecholamines in children. | | Language | eng | | Pub Type(s) | Journal Article
| | PubMed ID | 15803052 |
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