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Wiener Medizinische Wochenschrift

, Volume 161, Issue 7–8, pp 192–203 | Cite as

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

  • Sascha MeyerEmail author
  • William McGuire
  • Sven Gottschling
  • Ghiath Mohammed Shamdeen
  • Ludwig Gortner
Themenschwerpunkt

Summary

INTRODUCTION: Arginine-vasopressin (AVP) and terlipressin (TP) are used as rescue drugs for states of shock and cardio-circulatory failure. METHODS: Review to assess AVP/TP as a rescue therapy in children with catecholamine-resistant shock or cardio-circulatory arrest. RESULTS: A total of 31 reports were included (428 patients); sixteen articles were case series, 10 case reports, 3 clinical evaluation studies, one study was a non-blind RCT while one study was a multicentre double-blind RCT. The most common indication for either drug was catecholamine-refractory septic shock (12 reports). Commonly reported responses following AVP/TP administration were a rapid increase in blood pressure, an increase in urine output, and a decrease in serum lactate. In most reports, AVP and TP led to the reduction of catecholamines. The cumulative mortality rate remained high (188/428; 43.9%) despite the use of AVP/TP. CONCLUSIONS: No firm recommendations on the use of AVP/TP in children with severe forms of cardio-circulatory failure can be issued.

Keywords

Vasopressin Terlipressin Schock Septisch Kardiogen Katecholamin-refraktär 

Keywords

Vasopressin Terlipressin Shock Septic Cardiogenic Catecholamine-refractory 

Abbreviations:

AVP

Arginine-vasopressin

TP

Terlipressin

ELBW

Extremely low birth weight infants

N/A

Not applicable

Die Rolle von Vasopressin und Terlipressin beim katecholamin-refraktären Schock und Reanimation im Kindesalter: eine Literaturübersicht

Zusammenfassung

GRUNDLAGEN: Der katecholamin-refraktäre Schock und das Herz-Kreislaufversagen im Kindesalter sind mit einer hohen Morbidität und Mortalität assoziiert. In den letzten Jahren wird zunehmend Vasopressin und Terlipressin als "Rescue-Drug" für das fortgeschrittene Kreislaufversagen im Rahmen eines Schocks sowie bei der Reanimation im Kindesalter eingesetzt. METHODIK: Wir führten eine Medline/Embase-Literaturrecherche durch, um den Einsatz von Vasopressin und Terlipressin beim katecholamin-refraktären Schock sowie bei der Reanimation im Kindesalter zu evaluieren. ERGEBNISSE: Es wurden 31 Veröffentlichungen (Gesamtpatientenzahl: 428) zu dieser Thematik in diese Übersichtsarbeit eingeschlossen. 16 Arbeiten waren Fallserien, 10 Kasuistiken, 3 klinische Evaluierungsstudien, 1 Arbeit war eine nicht-geblindete randomisierte klinische Studie und 1 Arbeit war eine Multi-Center randomisierte Doppelblind-Studie; nur 6 Studien waren prospektiv angelegt. Das Alter der eingeschlossenen Patienten zeigte eine sehr große Streuung (extremes Frühgeborenes der 23. SSW bis Patienten mit 19 Jahren). Die häufigste Indikation zum Einsatz von Vasopressin/Terlipressin war der septische Schock (12 Berichte). Die Gabe von Vasopressin/Terlipressin führte regelmäßig zu einem Blutdruckanstieg, einer Zunahme der Urinausscheidung und zu einem Abfall der Laktatkonzentration im Serum. In den meisten Veröfffentlichungen konnte die Dosis der konventionellen Katecholamine nach Vasopressin-/Terlipressingabe reduziert werden. Die Gesamtmortalität blieb trotz Gabe von Vasopressin/Terlipresssin hoch (188/428; 43.9 %). SCHLUSSFOLGERUNGEN: Auf der Basis der bisher publizierten Daten kann keine generelle Empfehlung für die Gabe von Vasopresin und Terlipressin beim katechecholamin-refraktären Schock sowie im Rahmen der Reanimation im Kindesalter ausgesprochen werden. Zwei kürzlich publizierte, randomisierte klinische Studien ergaben widersprüchliche Ergebnisse. Vasopressin/Terlipressin kann möglicherweise im Rahmen eines individuellen Heilversuchs zum Einsatz kommen. Größere prospektive Studien sind erforderlich, um den Stellenwert dieser Substanzen im Kindesalter genauer zu evaluieren.

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Sascha Meyer
    • 1
    Email author
  • William McGuire
    • 2
  • Sven Gottschling
    • 3
  • Ghiath Mohammed Shamdeen
    • 3
  • Ludwig Gortner
    • 1
  1. 1.Department of Paediatrics and Paediatic Intensive Care MedicineUniversity Hospital of SaarlandHomburgGermany
  2. 2.Centre for ReviewsYorkUnited Kingdom
  3. 3.Department of PaediatricsUniversity Hospital of SaarlandHomburgGermany

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