ABSTRACT 520

Abstract

Background and aims: A significant proportion of pediatric patients develop catecholamine refractory septic shock and it is under higher mortality risk. In this context, vasopressin is a promissory medication. Aims: To describe the hemodynamic changes occurred in the first hours of the usage of vasopressin as rescue-therapy in patients with catecholamine-refractory septic shock. Methods: Retrospective study, in a Brazilian multidisciplinary tertiary Pediatric Intensive Care Unit, describing the five-years experience with the usage of vasopressin as rescue-therapy in children with catecholamine-refractory septic shock (noradrenaline > 1 μg/kg/min and variable doses of other inotropes/vasopressor). With paired Student t test, we compared the arterial blood pressures means in the period of two hours prior (T-2) the usage of vasopressin with the means in the period of 10 hours with (T10) the usage of vasopressin. The IRB approved the study and waived the need for informed consent. Results: In 16 patients, the median initial dose of vasopressin was 0,0005 U/kg/min [AIQ] 0,00024-0,00168. The mean blood pressures and the diastolic blood pressures increased with the usage of vasopressin (t=2,457; p=0,0267; t=2,617; p 0,0194, respectively). We observed increase in the modified vasoactive scores, which were unrelated with the alterations in the blood pressures of the patients. Conclusions: the vasopressin increased the blood pressures of the patients, however without a catecholamine spare effect. It is relevant that the future pediatric randomized trials with vasopressin as a rescue therapy in septic shock appraise using the medication earlier, with lower doses of noradrenaline.