The role of vasopressin and terlipressin in catecholamine-resistant shock in children: Review of the literature

Background and study purpose: Standard therapies for septic shock include fluid resuscitation and conventional inotropes. However, in progressed states of shock, cardio-circulatory failure may be unreponsive to conventional therapies secondary to profound vasoparalysis. Patients and methods: We performed a literature review to assess the use of arginine-vasopressin (AVP) and terlipressin (TP) as a rescue therapy in the pediatric population with catecholamine-resistant shock or cardio-circulatory arrest. Results: 27 reports were found with a total of 422 patients; thirteen articles were descriptive case serie, 9 were case reports, three were clinical evaluation studies, one study was a non-blind randomised control trial while one study was a multi center double-blind randomised control trial. Only 5 studies were prospective. There was a great range in age of treated patients (extremely low birth weight infants with 23 weeks gestation to 19-year-old adolescent). The most common indication for either drug was catecholamine-refractory septic shock (12 reports). Commonly reputed responses following AVP/TP administration were a rapid increase in arterial blood pressure, an increase in urine output, and a decrease in serum lactate. In most reports, AVP and TP had a positive impact on the dose of inotropes. The cumulative mortality rate remained high (149/422; 35.2%) despite the use of AVP/TP. Conclusions: Based on the current date available, no firm recommendations on the use of AVP/TP in children with severe forms of cardio-circulatory failure can be issued. The use of AVP/TP as a rescue therapy should be considered on an individual basis. Larger prospective trials assessing the efficacy and safety profiles of these drugs are necessary.