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Indian Pediatrics

, Volume 49, Issue 4, pp 297–305 | Cite as

Therapeutic applications of vasopressin in pediatric patients

  • Amit AgrawalEmail author
  • Vishal K. Singh
  • Amit Varma
  • Rajesh Sharma
Review Article

Abstract

Context

Reports of successful use of vasopressin in various shock states and cardiac arrest has lead to the emergence of vasopressin therapy as a potentially major advancement in the management of critically ill children.

Objective

To provide an overview of physiology of vasopressin, rationale of its use and dose schedule in different disease states with special focus on recent advances in the therapeutic applications of vasopressin.

Data Source

MEDLINE search (1966–September 2011) using terms “vasopressin”, “terlipressin”, “arginine-vasopressin”, “shock”, “septic shock”, “vasodilatory shock”, “cardiac arrest”, and “resuscitation” for reports on vasopressin/terlipressin use in children and manual review of article bibliographies. Search was restricted to human studies. Randomized controlled trials, cohort studies, evaluation studies, case series, and case reports on vasopressin/terlipressin use in children (preterm neonates to 21 years of age) were included. Outcome measures were analysed using following clinical questions: indication, dose and duration of vasopressin/terlipressin use, main effects especially on systemic blood pressure, catecholamine requirement, urine output, serum lactate, adverse effects, and mortality.

Results

51 reports on vasopressin (30 reports) and terlipressin (21 reports) use in pediatric population were identified. A total of 602 patients received vasopressin/terlipressin as vasopressors in various catecholamine-resistant states (septic - 176, post-cardiotomy - 136, other vasodilatory/mixed shock — 199, and cardiac arrest - 101). Commonly reported responses include rapid improvement in systemic blood pressure, decline in concurrent catecholamine requirement, and increase in urine output; despite these effects, the mortality rates remained high.

Conclusion

In view of the limited clinical experience, and paucity of randomized controlled trials evaluating these drugs in pediatric population, currently no definitive recommendations on vasopressin/terlipressin use can be laid down. Nevertheless, available clinical data supports the use of vasopressin in critically ill children as a rescue therapy in refractory shock and cardiac arrest.

Key words

Cardiac arrest Children Shock Terlipressin Vasopressin 

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Copyright information

© Indian Academy of Pediatrics 2012

Authors and Affiliations

  • Amit Agrawal
    • 1
    • 4
    Email author
  • Vishal K. Singh
    • 2
  • Amit Varma
    • 2
  • Rajesh Sharma
    • 3
  1. 1.Department of PediatricsChirayu Medical College and HospitalBhopalIndia
  2. 2.Department of Critical Care MedicineEscorts Heart Institute and Research CenterNew DelhiIndia
  3. 3.Department of Pediatric Cardiac SurgeryEscorts Heart Institute and Research CenterNew DelhiIndia
  4. 4.Near Nizamuddin ColonyIndrapuri, BhopalIndia

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