Continuous Terlipressin Infusion as Rescue Treatment in a Case Series of Children with Refractory Septic Shock

Abstract

Continuous terlipressin infusion may improve hemodynamics and survival in some children with refractory septic shock. Terlipressin could contribute to tissue ischemia.

Surviving Sepsis Campaign

“…In the initial resuscitation phase, inotrope/vasopressor therapy may be required to sustain perfusion pressure, even when hypovolemia has not yet been resolved. Indeed, two RCTs showed no benefit in outcome with use of vasopressin or terlipressin in children (556)(557)(558)(559). A child may move from one hemodynamic state to another.…”

Cardiovascular Drug Therapy for Human Newborn: Review of Pharmacodynamic Data

“…However there are some disadvantages including potentially greater untoward effects on peripheral perfusion [85][86][87].…”

“…The reason underlying rare use of AVP in the neonatal population may be the fear of potential untoward effects of the medication characterized with peripheral ischemia due to severe vasoconstriction, decreased mesenteric or renal blood flow, hyponatremia, elevated liver enzymes and effects on platelet aggregation which have been reported in adults [102]. These effects could be more overt if AVP is co-administered with another potent vasoconstrictor norepinephrine [82,87]. Most of the case series from newborns have not reported any of these effects.…”

“…However there is no similar data in neonatal population making it difficult for the physician to take action, although some authors prefer to take the same norepinephrine dose as a limit to start VP, while others prefer higher doses as limit [87,97]. There are many unknown issues in the use of these medications in newborn infants.…”

Septic Shock in Neonates

“…No evidence exists at present on the appropriate timing of TP initiation. Some data suggest that in infants TP should be administered when norepinephrine need is 0.5-2.5 µg/kg/min, probably a precocious administration may be beneficial in order to avoid episodes of severe hypotension (Filippi et al 2008, Zeballos et al 2006, Rodríguez-Núñez et al 2010. In adult preliminary clinical data on ultra low dose terlipressin infusion as first line agent, suggest that ''the earlier may be the better'' (Morelli et al 2008).…”