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PEDIATRICS

Terlipressin for Children with Extremely Low Cardiac Output After Open Heart Surgery

Pediatric Clinical Pharmacist, Department of Pediatric Intensive Care, Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Israel

Marina Rubinshtein, MD

Pediatric Intensive Care Specialist, Department of Pediatric Critical Care Medicine, Safra Children's Hospital, Sheba Medical Center

Amalia Levy, PhD

Epidemiologist, Researcher, Epidemiology and Health Services Evaluation Department, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel

Amir Vardi, MD

Pediatric Intensive Care Specialist, Department of Pediatric Critical Care Medicine, Safra Children's Hospital, Sheba Medical Center; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel

Leah Leibovitch, MD

Neonatal Intensive Care Specialist, Department of Pediatric Critical Care Medicine, Safra Children's Hospital, Sheba Medical Center

David Mishali, MD

Director, Pediatric Cardiac Surgery Unit, Department of Pediatric Cardio-Thoracic Surgery, Sheba Medical Center; Sackler Faculty of Medicine, Tel-Aviv University

Zohar Barzilay, MD FCCM

Professor of Pediatric Medicine, Pediatric Intensive Care Specialist, Former Director, Pediatric Intensive Care Department, Department of Pediatric Critical Care Medicine, Safra Children's Hospital, Sheba Medical Center; Sackler Faculty of Medicine, Tel-Aviv University

Gideon Paret, MD MHA

Associate Professor of Pediatric Medicine, Director, Pediatric Intensive Care Department, Department of Pediatric Critical Care Medicine, Safra Children's Hospital, Sheba Medical Center; Sackler Faculty of Medicine, Tel-Aviv University

Reprints: Mr. Matok, Department of Pediatric Intensive Care, Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel, fax 972-3-5302885, matoki{at}zahav.net.il

BACKGROUND: Terlipressin, a long-acting analog of vasopressin, has been used successfully in patients with extremely low cardiac output, but its application in children following open heart surgery is limited.

OBJECTIVE: To describe our experience using terlipressin in children with extremely low cardiac output after open heart surgery.

METHODS: Records were reviewed of all pediatric patients between January 2003 and December 2005 who had undergone open heart surgery, experienced extremely low cardiac output, and were treated with terlipressin as rescue therapy. Mean arterial blood pressure, heart rate, urine output, and lactate and oxygenation index values were retrieved and analyzed when available.

RESULTS: Twenty-nine children who were considered gravely ill despite conventional vasoactive agents received terlipressin as rescue therapy, which rapidly yielded significant improvements in all measured hemodynamic and respiratory indices. Mean ± SD arterial blood pressure increased significantly, from 49 ± 17 to 57 ± 16 mm Hg after 10 minutes (p = 0.004) and to 64 ± 15 mm Hg 24 hours after treatment onset (p = 0.001). Twenty-four hours following terlipressin administration, urine output increased from 1.5 ± 2.1 to 3.0 ± 2.3 mL/kg/h (p = 0.001), the oxygenation index decreased from 16.5 ± 27.9 to 9.5 ± 16.7 in the survivors (p = 0.023), and the inotropic score decreased from 41.9 ± 19.9 to 32.6 ± 18.8 (p = 0.009).

CONCLUSIONS: Terlipressin caused significant improvement in hemodynamic, respiratory, and renal indices in children with extremely low cardiac output after open heart surgery. Further controlled studies are needed to confirm the drug's safety and efficacy in this population.

Key Words: cardiac surgery, child, terlipressin, vasodilatory shock, vasopressin

Published Online, March 3, 2009. www.theannals.com, DOI 10.1345/aph.1L199

This article has been cited by other articles:

				S. Meyer Comment: Terlipressin for Children with Extremely Low Cardiac Output After Open Heart Surgery Ann. Pharmacother., July 1, 2009; 43(7): 1375 - 1376. [Full Text] [PDF]