Terlipressin for catecholamine-resistant septic shock in children

Abstract

Objective: To report the effects of terlipressin treatment in four paediatric patients with catecholamine-resistant hypotensive septic shock.

Design and setting: Case report in the pediatric intensive care unit of a university hospital.

Patients: Four children with severe septic shock and hypotension resistant to high doses of norepinephrine and other cathecolamines.

Interventions: Terlipressin was added to the standard treatment, by intravenous bolus at a dose of 0.02 mg/kg every 4 h during a maximum time of 3 days.

Measurement and results: In all cases, terlipressin induced a rapid and sustained improvement in mean arterial pressure, which allowed the lessening or even withdrawal of norepinephrine infusion. No related adverse effects were detected.

Conclusion: Terlipressin might be considered, at least as a rescue therapy, for hypotension resistant to catecholamines in children with septic shock. Further studies are needed to confirm the beneficial effects found in our patients. The optimal administration schedule remains to be elucidated.