Vasopressin in catecholamine-refractory shock in children

Anaesthesia. 2008 Mar;63(3):228-34. doi: 10.1111/j.1365-2044.2007.05317.x. Epub 2007 Dec 13.


Severe septic and cardiogenic shock is associated with a high mortality in neonates, children and adolescents. Common therapies include the administration of fluids and the use of conventional inotropes. However, in severe forms of shock, cardio-circulatory failure may be secondary to profound vasoparalysis and unresponsive to conventional therapies. We reviewed the literature on the use of arginine-vasopressin (AVP) and terlipressin (TP) as a rescue therapy in neonates, children and adolescents with catecholamine-refractory shock or cardio-circulatory arrest. We identified 17 reports (11 case series, 6 case reports) on a total of 109 patients. Only two studies were prospective. The age of treated patients ranged from extremely low birth weight infants of 23 weeks' gestation to a 19-year-old adolescent. The most common indication for either drug was catecholamine-refractory septic shock (nine reports). Commonly reported responses following AVP/TP administration were a rapid increase in systemic arterial blood pressure, an increase in urine output, and a decrease in serum lactate. In most reports, AVP and TP had a significant impact on the required dose of inotropes which could be reduced. Despite the use of AVP/TP, mortality was high (52/109). In view of the limited number of paediatric patients treated with AVP/TP, no definite recommendations on their use in children with severe forms of cardio-circulatory failure can be issued. There is a need for larger prospective trials assessing the efficacy and safety profiles of these drugs in a defined setting. Until more data are available, and taking into consideration the detrimental impact catecholamine-refractory shock has on children, the use of AVP/TP as a rescue therapy should be considered on an individual basis.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Adult
  • Arginine Vasopressin / adverse effects
  • Arginine Vasopressin / blood
  • Arginine Vasopressin / therapeutic use*
  • Blood Pressure / drug effects
  • Catecholamines / therapeutic use*
  • Child
  • Child, Preschool
  • Dose-Response Relationship, Drug
  • Humans
  • Infant
  • Infant, Newborn
  • Lactic Acid / blood
  • Lypressin / adverse effects
  • Lypressin / analogs & derivatives*
  • Lypressin / therapeutic use
  • Shock / blood
  • Shock / drug therapy*
  • Terlipressin
  • Treatment Failure
  • Urine
  • Vasoconstrictor Agents / adverse effects
  • Vasoconstrictor Agents / therapeutic use*


  • Catecholamines
  • Vasoconstrictor Agents
  • Arginine Vasopressin
  • Lactic Acid
  • Lypressin
  • Terlipressin