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Safety and Efficacy of Terlipressin in Pediatric Distributive Shock: A Retrospective Analysis in 20 Children

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Abstract

Introduction

Data are still lacking about the use of terlipressin or vasopressin in the treatment of pediatric patients who are in a state of therapy-refractory shock.

Objective

The aim of this study was to evaluate the effect of terlipressin on hemodynamics in children with distributive shock and to describe any severe side effects.

Methods

Consecutive patients (n = 20) with catecholamine-resistant distributive shock who were treated with terlipressin were retrospectively enrolled in this study. We analyzed response in terms of mean arterial blood pressure, heart rate, vasoactive inotropic score (VIS), urinary output, and serum lactate.

Results

The hemodynamics of 12 children significantly improved within 6 h of commencing terlipressin (mean blood pressure increase of ≥20 % without VIS increase, or mean blood pressure increase of ≥10 % with VIS decrease of ≥10 %). The hemodynamics of eight patients did not improve, regardless of treatment dosage or duration. More children died in the responders group (n = 7 [58.3 %]) than in the non-responders group (n = 2 [25.0 %]), but this was not statistically significant. Two patients (one in each group) who received high dosages of terlipressin developed rhabdomyolysis. One case of Takotsubo cardiomyopathy was observed, which could be related to terlipressin.

Conclusions

Although treatment with terlipressin resulted in rapid positive hemodynamic responses in some children, it did not seem to have a positive effect in other pediatric patients. Therefore, the possible benefits of terlipressin should be always weighed against potential severe adverse effects.

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Authors and Affiliations

  1. Department of Pediatric Cardiology, Pulmology and Pediatric Intensive Care Medicine, University Children’s Hospital, Hoppe-Seyler-Str. 1, 72076, Tuebingen, Germany

    Jörg Michel, Michael Hofbeck, Gina Spiller, Hanna Renk, Matthias Kumpf & Felix Neunhoeffer

Authors
  1. Jörg Michel
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  2. Michael Hofbeck
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  3. Gina Spiller
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  4. Hanna Renk
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  6. Felix Neunhoeffer
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Correspondence to Jörg Michel.

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Approval

The study protocol was approved by the Ethics Committee of Tuebingen University Hospital, Germany (189/2013R).

Funding

No funding was received for the conduct of this study.

Conflict of interest

Jörg Michel, Michael Hofbeck, Gina Spiller, Hanna Renk, Matthias Kumpf, and Felix Neunhoeffer have no conflicts of interest that might be relevant to the contents of this manuscript.

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Michel, J., Hofbeck, M., Spiller, G. et al. Safety and Efficacy of Terlipressin in Pediatric Distributive Shock: A Retrospective Analysis in 20 Children. Pediatr Drugs 19, 35–41 (2017). https://doi.org/10.1007/s40272-016-0199-8

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  • DOI: https://doi.org/10.1007/s40272-016-0199-8

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