Title: Vasopressin and Terlipressin for Pediatric Refractory Shock
Authors: Dr Pradeep Kumar, Dr Sujit Kumar, Dr Alka Singh
DOI: https://dx.doi.org/10.18535/jmscr/v5i2.166
Abstract
Objective: To review the physiology and the published literature on the role of vasopressin in shock in children.
Results: Beneficial effects have been reported in vasodilatory shock and asystolic cardiac arrest in adults. Solid evidence for vasopressin use in children is scanty. Observational studies have reported an improvement in blood pressure and rapid weaning off of catecholamines during administration of low-dose vasopressin. Dosing in children is extrapolated from adult studies.
Conclusions: Vasopressin offers promise in shock and cardiac arrest in children. However, in view of the limited experience with vasopressin, it should be used with caution. Results of a double blind, randomized controlled trial in children with vasodilatory shock will be available soon.
Keywords: Children; cardiac arrest; inotrope; vasopressin; shock; septic shock.
References
1. Watson RS, Carcillo JA, Walter T, et al: The epidemiology of severe sepsis in children in the United States. Am J Respir Crit Care Med 2003; 167:695–701
2. Landry DW, Oliver JA: The pathogenesis of vasodilatory shock. N Engl J Med 2001; 345: 588 –595
3. Mullner M, Urbanek B, Havel C, et al: Vasopressors for shock. Cochrane Database Syst Rev 2004; CD003709
4. Farand P, Hamel M, Lauzier F, et al: Review article: Organ perfusion/ permeability-related effects of norepinephrine and vasopressin in sepsis. Can J Anesth 2006; 53:934 –946
5. McNamara PJ: Too much of a good thing?
6. Oliver GS, Schäfer EA: On the physiological action of extracts of pituitary body and certain other glandular organs. J Physiol (Lond) 1895; 18:277–279
7. Carcillo JA, Fields AI: Clinical practice parameters for hemodynamic support of pediatric and neonatal patients in septic shock. Crit Care Med 2002; 30:1365–1378
8. Mutlu GM, Factor P: Role of vasopressin in the management of septic shock. Intensive Care Med 2004; 30:1276 –1291
9. Russell JA: Vasopressin in vasodilatory and septic shock. Curr Opin Crit Care 2007; 13: 383–391
10. Velden RVD: Die Nierenwirkung con Hypophysenextrakten beim Menschen. Berl Klin Wochenschr 1913; 50:2083–2086
11. Du Vigneaud V, Gish DT, Katsoyannis P: A synthetic preparation possessing biological properties associated with arginine-vasopressin. J Am Chem Soc 1954; 76:4751– 4752
12. Treshcan TA, Peters J: The vasopressin system: Physiology and clinical strategies. Anesthesiology 2006; 105:599 – 612
13. Holmes CL, Landry DW, Granton JT: Science review: Vasopressin and the cardiovascular system part 1—Receptor physiology. Crit Care 2003; 7:427– 434
14. Forrest P: Vasopressin and Shock. Anaesth Intensive Care 2001; 29:463– 472
15. Dünser MW, Wenzel V, Mayr AJ, et al: Management of vasodilatory shock: Defining the role of arginine vasopressin. Drugs 2003; 63: 237–256
16. Shrier R, Berl T, Anderson R: Osmotic and nonosmotic control of vasopressin release. Am J Physiol 1979; 236:F321–F332
17. Oliver JA, Landry DW: Endogenous and exogenous vasopressin in shock. Curr Opin Crit Care 2007; 13:376 –382
18. Hirsch A, Majzoub J, Ren C, et al: Contribution of vasopressin to blood pressure regulation during hypovolemic hypotension in humans. J Appl Phyisiol 1993; 75:1984 –1988
19. Kasting N, Mazurek M, Martin J: Endotoxin increases vasopressin release independently of known physiological stimuli. Am J Physiol 1985; 248:E420 –E424
20. Chikanza I, Petrou P, Chrousos G: Perturbations of arginine vasopressin secretion during inflammatory stress: Pathophysiologic implications. Ann NY Acad Sci 2000; 917: 825– 834