Vasopressin in pediatric shock

Vasopressin has been used in both adult and pediatric vasodilatory shock and cardiac arrest. The evidence in this area is primarily adult based, while pediatric specific data is more limited. The rationale for vasopressin in shock is based on the following: 1) it reverses the key mechanisms responsible for pathologic vasodilatation and catecholamine resistance, 2) despite its potent systemic vasoconstrictor properties, vasopressin has concurrent organ-specific vasodilator effects that may result in preserved vital organ perfusion; 3) vasopressin influences multiple other hormone responses which may modulate hypothalamicpituitary axis dysfunction and cellular immune response during septic shock; and 4) vasopressin insufficiency, and an increased sensitivity to the pressor effects of exogenous vasopressin has been demonstrated in both adults and perhaps children with septic shock. There are to date a total of 40 published pediatric studies evaluating the use of vasopressin in shock, reporting on a collective total of only 642 children. 35 of these studies are in shock, and 5 studies are in cardiac arrest. The vast majority of studies are case reports or case series. Only 2 of these studies are randomized controlled trials (RCT) - one of which was a multi-centred, double-blind RCT of arginine vasopressin in 69 patients vasodilatory shock, while the other was an open-label 58 patient RCT of terlipressin in catecholamine-resistant septic shock While there may be some evidence of short-term benefits with no increased risk of adverse effects, there has been no demonstrable superiority of vasopressin over traditional vasoactive agents on patient important outcomes such as survival, in children with catecholamine-refractory shock and cardiopulmonary arrest. As a result, vasopressin is not currently recommended as a first line vasoactive agent in pediatric patients with hemodynamic instability. The mortality rate amongst children with shock remains unacceptably high, ranging from 15-70%. As a result, these challenges and controversies rationalize the importance of ongoing prospective research on a potential role for vasopressin in the setting of pediatric shock. © 2013 by Nova Science Publishers, Inc. All rights reserved.