O papel da vasopressina e do seu análogo terlipressina no choque refratário em crianças

Abstract

Vasopressin and its analogue terlipressin have been used as rescue therapy in adult and children with refractory shock. Yet, the current data in pediatric field is not sufficient to clearly state its safety and efficacy. The authors conducted a systematic review following the PRISMA guidelines. The search was performed using Pubmed, Scopus and Web of Science's databases for publications released between the year 2000 and 2020. Studies regarding the use of vasopressin and terlipressin to treat vasodilatory shock or hypotension refractory to conventional therapy in the pediatric population were included. Thirty-seven studies met the eligible criteria. Only two studies included were randomized control trial that compared vasopressin or terlipressin to conventional therapy. We evaluated mortality as primary outcome, and mean arterial pressure, heart rate, urine output, lactate serum level, vasoactive inotropic score, oxygen index and adverse events, as secondary outcomes. The cumulative mortality rate was 38% and a higher mortality rate was observed in heterogenous group and septic shock. Regarding the secondary outcomes, an improvement was observed in most of the studies who evaluate these parameters. The most common adverse events observed were ischemic lesions and hyponatremia. Conclusion: The present systematic review revealed that current data remained insufficient to prove vasopressin/terlipressin's safety and efficacy, however, an improvement in hemodynamics parameters was clearly noted and suggests that they could have a role in pediatric management of refractory shock. What Is Known: Vasopressin and its analogue terlipressin have potent vasoconstrictor properties. In refractory shock, it is currently used as rescue therapy. Yet, the level of recommendation remains low especially due to no change in survival rate. What Is New: The mortality rate remains high despite vasopressin/terlirpessin treatment, but an earlier administration could be associated with a better outcome. However, further clinical studies are needed to clearly state its efficacy and safety.