Skip to main content
Top
Published in: Intensive Care Medicine 3/2004

01-03-2004 | Neonatal and Pediatric Intensive Care

Terlipressin for catecholamine-resistant septic shock in children

Authors: Antonio Rodríguez-Núñez, Manuel Fernández-Sanmartín, Federico Martinón-Torres, Natalia González-Alonso, José María Martinón-Sánchez

Published in: Intensive Care Medicine | Issue 3/2004

Login to get access

Abstract

Objective

To report the effects of terlipressin treatment in four paediatric patients with catecholamine-resistant hypotensive septic shock.

Design and setting

Case report in the pediatric intensive care unit of a university hospital.

Patients

Four children with severe septic shock and hypotension resistant to high doses of norepinephrine and other cathecolamines.

Interventions

Terlipressin was added to the standard treatment, by intravenous bolus at a dose of 0.02 mg/kg every 4 h during a maximum time of 3 days.

Measurement and results

In all cases, terlipressin induced a rapid and sustained improvement in mean arterial pressure, which allowed the lessening or even withdrawal of norepinephrine infusion. No related adverse effects were detected.

Conclusion

Terlipressin might be considered, at least as a rescue therapy, for hypotension resistant to catecholamines in children with septic shock. Further studies are needed to confirm the beneficial effects found in our patients. The optimal administration schedule remains to be elucidated.
Literature
1.
go back to reference Carcillo JA, Fields AI (2002) Clinical practice parameters for hemodynamic support of pediatric and neonatal patients in septic shock. Crit Care Med 30:1365–1378PubMed Carcillo JA, Fields AI (2002) Clinical practice parameters for hemodynamic support of pediatric and neonatal patients in septic shock. Crit Care Med 30:1365–1378PubMed
2.
go back to reference Malay MB, Ashton RCJ, Landry DW, Townsend RN (1999) Low-dose vasopressin in the treatment of vasodilatory septic shock. J Trauma 47:699–705PubMed Malay MB, Ashton RCJ, Landry DW, Townsend RN (1999) Low-dose vasopressin in the treatment of vasodilatory septic shock. J Trauma 47:699–705PubMed
3.
go back to reference O’Brien A, Clapp L, Singer M (2002) Terlipressin for norepinephrine-resistant septic shock. Lancet 359:1209–1210CrossRefPubMed O’Brien A, Clapp L, Singer M (2002) Terlipressin for norepinephrine-resistant septic shock. Lancet 359:1209–1210CrossRefPubMed
4.
go back to reference Dünser MW, Mayr AJ, Ulmer H, Ritsch N, Knotzer H, Pajk W, Luckner G, Mutz NJ, Hasibeder WR (2001) The effects of vasopressin on systemic hemodynamics in catecholamine-resistant septic and postcardiotomy shock: a retrospective analysis. Anesth Analg 93:7–13PubMed Dünser MW, Mayr AJ, Ulmer H, Ritsch N, Knotzer H, Pajk W, Luckner G, Mutz NJ, Hasibeder WR (2001) The effects of vasopressin on systemic hemodynamics in catecholamine-resistant septic and postcardiotomy shock: a retrospective analysis. Anesth Analg 93:7–13PubMed
5.
go back to reference Tsuneyoshi I, Yamada H, Kakihana Y, Nakamura M, Nakano Y, Boyla WA (2001) Hemodynamic metabolic effects of low-dose vasopressin infusions in vasodilatory septic shock. Crit Care Med 29:487–493PubMed Tsuneyoshi I, Yamada H, Kakihana Y, Nakamura M, Nakano Y, Boyla WA (2001) Hemodynamic metabolic effects of low-dose vasopressin infusions in vasodilatory septic shock. Crit Care Med 29:487–493PubMed
6.
go back to reference Holmes CL, Walley KR, Chittock DR, Lehman T, Russell JA (2001) The effects of vasopressin on hemodynamics and renal function in severe septic shock: a case series. Intensive Care Med 27:1416–1421PubMed Holmes CL, Walley KR, Chittock DR, Lehman T, Russell JA (2001) The effects of vasopressin on hemodynamics and renal function in severe septic shock: a case series. Intensive Care Med 27:1416–1421PubMed
7.
go back to reference Asfar P (2003) Terlipressin in chronic hyperdynamic endotoxic shock: Is it safe? Intensive Care Med 29:154–155PubMed Asfar P (2003) Terlipressin in chronic hyperdynamic endotoxic shock: Is it safe? Intensive Care Med 29:154–155PubMed
8.
go back to reference Ioannou G, Doust J, Rockey DC (2003) Terlipressin for acute esophageal variceal hemorrhage (Cochrane Review). Cochrane Database Syst Rev CD002147 Ioannou G, Doust J, Rockey DC (2003) Terlipressin for acute esophageal variceal hemorrhage (Cochrane Review). Cochrane Database Syst Rev CD002147
9.
go back to reference Moreau R (2002) Hepatorenal syndrome in patients with cirrhosis. J Gastroenterol Hepatol 17:739–747CrossRefPubMed Moreau R (2002) Hepatorenal syndrome in patients with cirrhosis. J Gastroenterol Hepatol 17:739–747CrossRefPubMed
10.
go back to reference Landry D, Oliver J (2001) The pathogenesis of the vasodilatory shock. N Engl J Med 345:588–595PubMed Landry D, Oliver J (2001) The pathogenesis of the vasodilatory shock. N Engl J Med 345:588–595PubMed
11.
go back to reference Landry DW, Levin HR, Gallant EM, Ashton RC, Seo S, D’Alesandro D, Oz MC, Oliver JA (1997) Vasopressin deficiency contributes to the vasodilatation of septic shock. Circulation 95:1122–1125PubMed Landry DW, Levin HR, Gallant EM, Ashton RC, Seo S, D’Alesandro D, Oz MC, Oliver JA (1997) Vasopressin deficiency contributes to the vasodilatation of septic shock. Circulation 95:1122–1125PubMed
12.
go back to reference De Keulenaer BL, Stephens DP (2003) Comment on “Terlipressin in chronic hyperdynamic endotoxic shock: Is it safe?” by P. Asfar. Intensive Care Med 29:854PubMed De Keulenaer BL, Stephens DP (2003) Comment on “Terlipressin in chronic hyperdynamic endotoxic shock: Is it safe?” by P. Asfar. Intensive Care Med 29:854PubMed
13.
go back to reference Scharte M, Meyer J, Van Aken H, Bone HG (2001) Hemodynamic effects of terlipressin (a synthetic analog of vasopressin) in healthy and endotoxemic sheep. Crit Care Med 29:1756–1760PubMed Scharte M, Meyer J, Van Aken H, Bone HG (2001) Hemodynamic effects of terlipressin (a synthetic analog of vasopressin) in healthy and endotoxemic sheep. Crit Care Med 29:1756–1760PubMed
14.
go back to reference Dünser MW, Mayr AJ, Tür A, Pajk W, Barbara F, Knotzer J, Ulmer H, Hasibeder WR (2003) Ischemic skin lesions as a complication of continuous vasopressin infusion in catecholamine-resistant vasodilatory shock: incidence and risk factors. Crit Care Med 31:1394–1398CrossRefPubMed Dünser MW, Mayr AJ, Tür A, Pajk W, Barbara F, Knotzer J, Ulmer H, Hasibeder WR (2003) Ischemic skin lesions as a complication of continuous vasopressin infusion in catecholamine-resistant vasodilatory shock: incidence and risk factors. Crit Care Med 31:1394–1398CrossRefPubMed
15.
go back to reference Westphal M, Bone HG, Van Aken H, Sielenkämper AW (2002) Terlipressin for haemoynamic support in septic patients: a double-edged sword? Lancet 360:1250–1251CrossRef Westphal M, Bone HG, Van Aken H, Sielenkämper AW (2002) Terlipressin for haemoynamic support in septic patients: a double-edged sword? Lancet 360:1250–1251CrossRef
Metadata
Title
Terlipressin for catecholamine-resistant septic shock in children
Authors
Antonio Rodríguez-Núñez
Manuel Fernández-Sanmartín
Federico Martinón-Torres
Natalia González-Alonso
José María Martinón-Sánchez
Publication date
01-03-2004
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 3/2004
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-003-2114-3

Other articles of this Issue 3/2004

Intensive Care Medicine 3/2004 Go to the issue