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Newborns with hypotension
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| bet | 635/654 | | Sana | 03.01.2022 | | Hajmi | 1,5 Mb. | | #14803 |
Newborns with hypotension: A pilot trial in preterm infants born < 30 weeks gestation with refractory hypotension (n = 20) of argipressin (0.01 units/kg/h to maximum 0.04 units/kg/hour) versus dopamine (5 to 20 microg/kg/min) reported similar increases in blood pressure. Infants receiving argipressin received fewer doses of surfactant, had lower PaCO2 values and were less tachycardic. No difference in clinical outcome was reported.3 The role of argipressin for hypotension in newborns is unclear (LOE II, GOR D).
Children with refractory hypotension: A review4 of argipressin/terlipressin as rescue therapy in children with catecholamine-resistant shock or cardio-circulatory arrest found 31 reports (428 patients) including a single RCT of argipressin in children with vasodilatory shock. Infants with vasodilatory shock were randomised to low-dose argipressin (0.0005 to 0.002 units/kg/minute = 0.03 to 0.12 units/kg/hour) or placebo in addition to open-label vasoactive agents. There was no difference in time to vasoactive-free haemodynamic stability, a trend to increasing mortality and no benefit in respect to organ-failure-free days from use of argipressin. In observational studies, argipressin from 0.00002 unit/kg/minute to 0.002 unit/kg/minute (0.0012 to 0.12 units/kg/hour) increased blood pressure, urine output, and decreased serum lactate. In most reports, argipressin and terlipressin led to a reduction of catecholamine dose. However, mortality remained high (188/428; 43.9%) despite the use of argipressin or terlipressin. 4 The role of argipressin for refractory hypotension in newborns is unclear. (LOE IV in newborns, GOR D) American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock included argipressin as an option for management of vasodilatory shock (hypotension with low vascular resistance) refractory to catecholamines including noradrenaline (norepinephrine).5
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