Vasopressin as a pressor adjunct in various forms of severe hypotensive shock

Background and study purpose: Recent clinical investigations have demonstrated that vasopressin (VPA) may be a valuable alternative or adjunct to common pressor agents in various forms of shock. Although, typically septic shock is characterized by VPA deficiency and pressor hypersensitivity to the exogenous hormone, VPA has also been successfully employed in other shock forms that are usually not characterised by VPA deficiency (1–4). Patients and methods: Patient 1 was a one-year old boy with Waterhouse-Friderichsen-syndrome. He was admitted to the hospital in septic shock. Mean arterial blood pressure could only be restored by high dose volume resuscitation, catecholamines, and VPA administration. Patient 2 was a 14-year-old boy with pulmonary atresia who underwent cardiac surgery for reconstruction of the right ventricular outflow tract. After prolonged surgery with a total extracorporeal circulation time of 210min, the patient suffered post-operatively from severe diffuse bleeding which required the administration of fresh frozen plasma, platelets, packed red blood cell concentrates, and activated factor VII. MAP could only be stabilised after high dose catecholamine and VPA medication. Patient 3 was a 15-month-old boy who was admitted to the hospital with asystole and a body temperature of C after a submersion accident in ice water. Cardio-circulatory function 24.9 could only be restored by external cardiac pacing, high dose catecholamine, and VPA medication. Conclusions: This report demonstrates the efficacy of VPA in restoring arterial blood pressure in various forms of shock (septic, haemorrhagic, hypotensive-hypothermic) in children. VPA may be a viable pressor adjunct for children with severe hypotensive shock resulting from sepsis, severe hypovolaemia secondary to hemorrhage, and cardio-circulatory depression resulting from submersion accidents when conventional therapies fail. Further prospective assessment of VPA safety and efficacy as a pressor adjunct in children with intractable hypotension is warranted. Assessment of endogenous VPA concentration may allow to define subgroups with distinct risk profiles.

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