Rescue Therapy In Children Research Articles

Arginine-vasopressin as a rescue therapy in children with cardiocirculatory failure

Arginine-vasopressin as a rescue therapy in children with cardiocirculatory failure

Arginine-vasopressin as a rescue therapy in children with cardiocirculatory failure

Arginine-vasopressin as a rescue therapy in children with cardiocirculatory failure

Author’s reply to the correspondence letter from Dr. S. Meyer et al. entitled arginine-vasopressin as a rescue therapy in children and neonates for catecholamine-resistant shock

We appreciate the interest in our study and the comments by Dr. Meyer and would like to respond to them. Our study reported the retrospectively analysed data of 17 neonates, who developed systemic inflammatory response syndrome (SIRS) with catecholamineresistant vasodilatory shock following open-heart surgery and were treated with lowdose continuous infusion of arginine-vasopressin (AVP). Despite the use of modified ultrafiltration uncontrolled release of proinflammatory cytokines may lead to SIRS after cardiopulmonary bypass. Especially neonates who undergo cardiac surgery with long bypass duration are at high risk to develop post bypass SIRS [2, 7]. This syndrome is not necessarily associated with cardiac dysfunction or cardiogenic shock. Both septic as well as post cardiopulmonary bypass-induced severe vasodilatation are associated with inappropriately low vasopressin plasma levels; so this vasopressin deficiency may contribute to the hypotension of vasodilatory shock [3, 4, 6]. Low dose continuous infusions of vasopressin have been successfully used in several trials in adults and children with vasodilatory shock secondary to open-heart surgery [1, 5, 6]. In accordance with these findings, our study showed that in neonates with vasodilatory shock refractory to traditional vasopressors after cardiac surgery vasopressin seems to be a potent agent to increase blood pressure and avoid end-organ failure. Because vasopressin is less appropriate for neonates with ventricular dysfunction [6], we took care not to use AVP in patients with cardiac dysfunction. One major limitation of our study was that we did not measure endogenous vasopressin levels prior to the initiation of AVP. We fully agree with the suggestion of Dr. Meyer that future clinical studies should assess endogenous vasopressin levels prior to the administration of exogenous AVP.

Arginine-vasopressin as a rescue therapy in children and neonates for catecholamine-resistant shock

Dear Editor, We read with interest the article by Lechner et al. on the use of arginine-vasopressin in neonates with vasodilatory shock after cardiopulmonary bypass [2]. As in previous studies [5], the authors could show that the administration of arginine-vasopressin caused a significant increase in systemic blood pressure and urine output, as well as a decrease in serum lactate concentrations in survivors. Interestingly, these effects were seen in neonates who had undergone cardiopulmonary bypass. Usually, the administration of arginine-vasopressin is most beneficial in patients with catecholamine-refractory septic shock with depletion of endogenous arginine-vasopressin and subsequent hypersensitivity to exogenous arginine-vasopressin. Conversely, endogenous arginine-vasopressin release is increased in cardiogenic shock causing a decreased response to exogenous arginine-vasopressin [1, 3, 4]. As the authors speculate, the response to arginine-vasopressin in their patient cohort may have been due to a systemic inflammatory response syndrome secondary to the cardiopulmonary bypass. As arginine-vasopressin will be used more frequently as a rescue therapy in children with various causes of catecholamine-refractory circulatory failure, we suggest that future clinical studies assess endogenous arginine-vasopressin levels prior to starting exogenous arginine-vasopressin. This will provide us with a better and more profound understanding of the effects of arginine-vasopressin in circulatory failure. Ultimately, the assessment of endogenous argininevasopressin concentration may help predict the success or failure of exogenous administration in individual patients.

Investigation of Pediatric Renal Transplant Recipients with Heavy Proteinuria after Sirolimus Rescue

Little is known about the incidence and evolution of proteinuria as a complication of sirolimus rescue in children. This study describes pediatric renal transplant (Tx) recipients who were treated with sirolimus and who developed heavy proteinuria. Risk factors for the development of proteinuria and its time course are explored. Data at various time points after sirolimus introduction were abstracted from the records of children treated at the author's center. The repeated measures general linear model and the Student's paired t test were used to analyze changes in laboratory values over time. Of the 13 children on sirolimus, 12 developed heavy proteinuria after a mean interval of 1 month. The mean urine protein (Up)-to-creatinine (c) ratio increased from 1.1 to a peak value of 3.9 (P=0.003) at 4.6 months after the start of sirolimus. Although not statistically significant, children on no calcineurin inhibitor (CNI) had a greater increase in the Up/c than those on low-dose CNI. At last follow-up, with the use of angiotensin receptor blockers (ARB), the Up/c declined to 2.2. No predictors could be identified for the development of proteinuria. Heavy proteinuria is common after the use of sirolimus as rescue therapy in children with renal Tx. Whether this is attributable to a toxic effect of the sirolimus itself or to lower CNI exposure is uncertain. Early detection of proteinuria is important to enable prompt intervention. Most children have a reduction in their Up/c with the use of ARB and can therefore be continued on sirolimus.

Cardiovascular News

HomeCirculationVol. 109, No. 16Cardiovascular News Free AccessNewsDownload EPUBAboutView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessNewsDownload EPUBCardiovascular News Ruth SoRelle, MPH Ruth SoRelleRuth SoRelle Circulation Newswriter Search for more papers by this author Originally published27 Apr 2004https://doi.org/10.1161/01.CIR.0000130113.51128.01Circulation. 2004;109:e9038C-Reactive Protein Levels at the ExtremesLevels of high sensitivity C-reactive protein at both ends of the spectrum provide important prognostic information about cardiovascular risk, said researchers from Harvard Medical School in this week’s issue of the journal Circulation(Circulation. 2004;109;1955–1959).Although high-sensitivity C-reactive protein is a known independent risk factor for cardiovascular events, patients with levels below 1 mg/L are considered to be at low risk, whereas those with levels between 1 and 3 mg/L are at considered to be at moderate risk and those with levels over 3 mg/L are considered to be high risk. These researchers, however, were concerned about what happened when the levels fell below 0.5 mg/L or went above 10 mg/L.They obtained the baseline levels of high sensitivity C-reactive protein in 27 939 apparently healthy women and followed them for myocardial infarction, stroke, coronary revascularization, or death from cardiovascular causes. The relative risks of these events were calculated across the different risk levels. The researchers, led by Paul M Ridker, MD, MPH, of Harvard found that the risks increased as the levels of high sensitivity C-reactive protein went up. For example, when the C-reactive protein level was less than 0.5 mg/L, the relative risk was 1. If it was between 2 and 3 mg/L, the relative risk was 3.5, and at levels above 20 mg/L, the relative risk was 7.6.When adjusted for Framingham Risk Score, the risks went down. For example, when the levels were over 20 mg/L, the relative risk was 3.1. The researchers noted that their findings provide important information about the need to use high sensitivity C-reactive protein measurements.Diet Plus Exercise Can Reverse Obesity-Related Vascular Dysfunction in ChildrenDiet plus exercise, continued at least a year, reduced the waist-to-hip ratio and cholesterol levels in children, as well as improving arterial endothelial function, said researchers in a report in this week’s issue of the journal Circulation(Circulation. 2004;109;1981–1986).Such studies are critical in the face of growing rates of obesity worldwide, said the scientists from Prince of Wales Hospital, The Chinese University of Hong Kong, and the Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia. The researchers, led by Kam S. Woo, MD, of Prince of Wales Hospital, randomly assigned 82 overweight children to dietary modification only or diet plus a supervised structured exercise program for 6 weeks and then a year. After 6 weeks, the children in both groups experienced decreased waist-to-hip ratios and lowered cholesterol levels. However, those in the diet plus exercise group had a significantly greater improvement in endothelial function than those in the diet only group. After 1 year, the group that continued exercise experienced significantly less thickening of the carotid wall, as well as lower body fat content and healthier lipid profiles.The researchers wrote, “. . .[I]mproving obesity-related arterial dysfunction in children by diet and exercise should be regarded as an important strategy for modifying vascular risk in this population.”High-Dose Epinephrine of No Benefit in In-Hospital Pediatric Cardiac ArrestHigh-dose epinephrine proved of no benefit as rescue therapy for children whose hearts had stopped in the hospital and who had already received a standard dose of epinephrine, said researchers in the April 22, 2004, issue of The New England Journal of Medicine (N Engl J Med. 2004; 350:1722–1730Google Scholar).This international group of researchers led by Maria Beatriz M. Perondi, MD, of the University of São Paulo School of Medicine in Brazil, enrolled 68 children in a study in which the youngsters were randomly assigned to receive high-dose epinephrine from 0.1 mg per kilogram of body weight to a standard dose treatment of 0.01 mg/ kilogram of body weight. They found a lower rate of survival at 24 hours for the children who received the high dose of epinephrine when compared to those who received the standard dose. The survival rate was low in each group: 1 of 34 in the high dose group and 7 of 34 in the standard dose group. None of the children in the high dose group survived to hospital discharge, whereas 4 of those in the standard dose group did.“The results of this study suggest that high-dose epinephrine rescue therapy in children with in-hospital cardiac arrest does not improve the rate of survival at 24 hours. Among children with asphyxia-precipitated cardiac arrest, high-dose epinephrine appears to be harmful,” the authors wrote. 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Sciatic Neuritis

<h3>Abstract</h3> <b>Overview of:</b> Medicines and Healthcare products Regulatory Agency. Nebulised asthma rescue therapy in children: home use of nebulisers in paediatric asthma should be initiated and managed only by specialists. <i>Drug Safety Update</i> 2022;16:1.