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Terlipressine shock

Tim G Kampmeier, Philip H Arnemann, Michael Hessler, Laura M Seidel, Karsten Becker, Andrea Morelli, Sebastian W Rehberg, Christian Ertmer
The Surviving Sepsis Guidelines suggest the use of vasopressin in case of catecholamine-refractory septic shock. Terlipressin (TP) as a V1 -selective AVP analogue is a potential alternative, though data regarding the first-line administration in septic shock are scarce. The present study explored and compared the effects of first-line vs. second-line infusion of TP or sole norepinephrine regarding organ function, fluid and norepinephrine requirements and survival in fulminant ovine septic shock. Peritoneal sepsis was induced in 23 ewes after laparotomy and faecal withdrawal from the caecum...
May 8, 2018: Scientific Reports
Hui-Chun Huang, Shao-Jung Hsu, Ching-Chih Chang, Ming-Hung Tsai, Fa-Yauh Lee, Ming-Chih Hou, Shou-Dong Lee
Critical illness is accompanied by hypothalamic-pituitary-adrenal axis activation, but adrenal insufficiency characterized by inadequate glucocorticoid synthesis is common in critically ill cirrhotic patients, the 'hepato-adrenal syndrome'. Adrenal cortex also synthesizes androgen (dehydroepiandrosterone, DHEA). DHEA maintains microcirculation by enhancing vascular endothelial nitric oxide synthase (eNOS) activity. In critical patients of other disease entities, a shift of adrenal steroidogenesis away from androgens towards glucocorticoid has been noted, arousing interests in androgen replacement in critical settings...
February 1, 2018: Shock
Sung Eun Kim, Dong Min Jung, Ji Won Park, Yeonmi Ju, Bohyun Lee, Hyoung Su Kim, Ki Tae Suk, Myoung Kuk Jang, Sang Hoon Park, Jun Goo Kang, Jae Seung Soh, Hyun Lim, Ho Suk Kang, Sung Hoon Moon, ChulSik Kim, SeongJin Lee, Jong Hyeok Kim, Myung Seok Lee, Dong Joon Kim, Sung-Hee Ihm, ChoongKee Park
OBJECTIVES: Terlipressin is safely used for acute variceal bleeding. However, side effects, such as hyponatremia, although very rare, can occur. We investigated the development of hyponatremia in cirrhotic patients who had acute variceal bleeding treated with terlipressin and the identification of the risk factors associated with the development of hyponatremia. DESIGN AND METHODS: This retrospective, case-control study investigated 88 cirrhotic patients who developed hyponatremia and 176 controls that did not develop hyponatremia and were matched in terms of age and gender during the same period following terlipressin administration...
2017: Gastroenterology Research and Practice
Zhi Chen, Ping Zhou, Yuanhua Lu, Chunli Yang
OBJECTIVE: To approach the effect of different vasopressor on hemodynamics, volume responsiveness, fluid volume balance, renal function and prognosis in patients with acute respiratory distress syndrome (ARDS) complicated with septic shock. METHODS: A prospective single-blind randomized controlled trial was conducted. ARDS patients with septic shock admitted to the Department of Critical Care Medicine of Jiangxi Provincial People's Hospital from January 1st, 2015 to May 1st, 2016 were enrolled...
February 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Keun Suk Park, Kyung Yeon Yoo
Arginine vasopressin (AVP), also known as antidiuretic hormone, is a peptide endogenously secreted by the posterior pituitary in response to hyperosmolar plasma or systemic hypoperfusion states. When administered intravenously, it causes an intense peripheral vasoconstriction through stimulation of V1 receptors on the vascular smooth muscle. Patients in refractory shock associated with severe sepsis, cardiogenic or vasodilatory shock, or cardiopulmonary bypass have inappropriately low plasma levels of AVP ('relative vasopressin deficiency') and supersensitivity to exogenously-administered AVP...
June 2017: Korean Journal of Anesthesiology
Claire Ragot, Edouard Gerbaud, Alexandre Boyer
Poisoning caused by calcium-channels blockers (CCB) can cause refractory vasoplegic shock, resulting in multiple-organ failure and death despite maximal therapy including high doses of vasopressors. We report one CCB-induced refractory shock complicated with lactate acidosis despite very high doses of epinephrine and norepinephrine. The hemodynamic status of the patient dramatically improved after intermittent boluses of terlipressin, which corrected the acidosis.
July 2017: American Journal of Emergency Medicine
Reem Masarwa, Gideon Paret, Amichai Perlman, Shimon Reif, Bruria Hirsh Raccah, Ilan Matok
BACKGROUND: Vasopressin (AVP) and terlipressin (TP) have been used as last-line therapy in refractory shock in children. However, the efficacy and safety profiles of AVP and TP have not been determined in pediatric refractory shock of different origins. We aimed to assess the efficacy and safety of the addition of AVP/TP therapy in pediatric refractory shock of all causes compared to conventional therapy with fluid resuscitation and vasopressor and inotropic therapy. METHODS: We conducted a systematic review, meta-analysis, and trial sequential analysis (TSA) comparing AVP and TP to conventional therapy...
January 5, 2017: Critical Care: the Official Journal of the Critical Care Forum
M Hessler, T G Kampmeier, S Rehberg
The present review initially describes the rationale for the use of non-adrenergic vasopressors in the treatment of distributive shock and then provides an overview of the individual vasopressin-receptor agonists, namely arginine vasopressin, terlipressin, and selepressin. Following a brief summary of their current use in clinical practice, the present review focuses on the influence of vasopressin-receptor agonists on macro- and microvascular coupling, also referred to as hemodynamic coherence. On the basis of the current evidence from experimental and clinical studies, vasopressin-receptor agonists do not negatively influence macro- and microvascular coupling as compared to the standard therapy with norepinephrine, when used in established treatment regimes...
December 2016: Best Practice & Research. Clinical Anaesthesiology
Jörg Michel, Michael Hofbeck, Gina Spiller, Hanna Renk, Matthias Kumpf, Felix Neunhoeffer
INTRODUCTION: Data are still lacking about the use of terlipressin or vasopressin in the treatment of pediatric patients who are in a state of therapy-refractory shock. OBJECTIVE: The aim of this study was to evaluate the effect of terlipressin on hemodynamics in children with distributive shock and to describe any severe side effects. METHODS: Consecutive patients (n = 20) with catecholamine-resistant distributive shock who were treated with terlipressin were retrospectively enrolled in this study...
February 2017: Paediatric Drugs
Ashok Choudhury, Chandan K Kedarisetty, Chitranshu Vashishtha, Deepak Saini, Sachin Kumar, Rakhi Maiwall, Manoj K Sharma, Ajeet S Bhadoria, Guresh Kumar, Yogendra K Joshi, Shiv K Sarin
BACKGROUND & AIMS: The choice of vasopressor for treating cirrhosis with septic shock is unclear. While noradrenaline in general is the preferred vasopressor, terlipressin improves microcirculation in addition to vasopressor action in non-cirrhotics. We compared the efficacy and safety of noradrenaline and terlipressin in cirrhotics with septic shock. PATIENTS AND METHODS: Cirrhotics with septic shock underwent open label randomization to receive either terlipressin (n=42) or noradrenaline (n=42) infusion at a titrated dose...
April 2017: Liver International: Official Journal of the International Association for the Study of the Liver
Rafael González, Javier Urbano, Jorge López, Maria J Solana, Marta Botrán, Ana García, Sarah N Fernández, Jesús López-Herce
BACKGROUND: Haemorrhagic shock is frequent in paediatric trauma patients and after cardiac surgery, especially after cardiopulmonary bypass. It has demonstrated to be related to bad outcome. OBJECTIVES: To evaluate changes on microcirculatory parameters during haemorrhagic shock and resuscitation in a paediatric animal model. To determine correlation between microcirculatory parameters and other variables routinely used in the monitoring of haemorrhagic shock. METHODS: Experimental study on 17 Maryland pigs...
February 2016: Injury
Alessandro Belletti, Mario Musu, Simona Silvetti, Omar Saleh, Laura Pasin, Fabrizio Monaco, Ludhmila A Hajjar, Evgeny Fominskiy, Gabriele Finco, Alberto Zangrillo, Giovanni Landoni
INTRODUCTION: Hypotensive state is frequently observed in several critical conditions. If an adequate mean arterial pressure is not promptly restored, insufficient tissue perfusion and organ dysfunction may develop. Fluids and catecholamines are the cornerstone of critical hypotensive states management. Catecholamines side effects such as increased myocardial oxygen consumption and development of arrhythmias are well known. Thus, in recent years, interest in catecholamine-sparing agents such as vasopressin, terlipressin and methylene blue has increased; however, few randomized trials, mostly with small sample sizes, have been performed...
2015: PloS One
Xudong Xiao, Jie Zhang, Yaoli Wang, Jian Zhou, Yu Zhu, Dongpo Jiang, Liangming Liu, Tao Li
Terlipressin (TP), an analog of arginine vasopressin, was reported beneficial in sepsis patients when combined use with norepinephrine (NE), but the undetermined action, mechanism, and safety limited it to become the first-line vasopressor for sepsis patients. With 32 septic shock patients, we investigated the effects of a small dose of TP (1.3 μg/kg/h) on hemodynamic, tissue blood flow, vital organ function, acid-base balance, and coagulation function to systemically know the beneficial effect and side effects of TP on septic shock...
January 2016: Journal of Surgical Research
Tomer Avni, Adi Lador, Shaul Lev, Leonard Leibovici, Mical Paul, Alon Grossman
OBJECTIVE: International guidelines recommend dopamine or norepinephrine as first-line vasopressor agents in septic shock. Phenylephrine, epinephrine, vasopressin and terlipressin are considered second-line agents. Our objective was to assess the evidence for the efficiency and safety of all vasopressors in septic shock. METHODS: Systematic review and meta-analysis. We searched electronic database of MEDLINE, CENTRAL, LILACS and conference proceedings up to June 2014...
2015: PloS One
Feihu Zhou, Zhi Mao, Xiantao Zeng, Hongjun Kang, Hui Liu, Liang Pan, Peter C Hou
OBJECTIVE: Vasopressor agents are often prescribed in septic shock. However, their effects remain controversial. We conducted a systematic review and Bayesian network meta-analysis to compare the effects among different types of vasopressor agents. DATA SOURCES: We searched for relevant studies in PubMed, Embase, and the Cochrane Library databases from database inception until December 2014. STUDY SELECTION: Randomized controlled trials in adults with septic shock that evaluated different vasopressor agents were selected...
2015: Therapeutics and Clinical Risk Management
Keila Kazue Ida, Denise Aya Otsuki, Adolfo Toshiro Cotarelli Sasaki, Emilyn Silva Borges, Letícia Urbano Cardoso Castro, Talita Rojas Sanches, Maria-Heloisa Massola Shimizu, Lúcia Conceição Andrade, José-Otávio Costa Auler, Alex Dyson, Kenneth John Smith, Joel Avancini Rocha Filho, Luiz-Marcelo Sá Malbouisson
INTRODUCTION: We investigated whether treatment with terlipressin during recovery from hypotension due to haemorrhagic shock (HS) is effective in restoring cerebral perfusion pressure (CPP) and brain tissue markers of water balance, oxidative stress and apoptosis. METHODS: In this randomised controlled study, animals undergoing HS (target mean arterial pressure (MAP) 40 mmHg for 30 minutes) were randomised to receive lactated Ringer's solution (LR group; n =14; volume equal to three times the volume bled), terlipressin (TERLI group; n =14; 2-mg bolus), no treatment (HAEMO group; n =12) or sham (n =6)...
2015: Critical Care: the Official Journal of the Critical Care Forum
Javier Urbano, Rafael González, Jorge López, María J Solana, José M Bellón, Marta Botrán, Ana García, Sarah N Fernández, Jesús López-Herce
INTRODUCTION: In series of cases and animal models suffering hemorrhagic shock, the use of vasopressors has shown potential benefits regarding hemodynamics and tissue perfusion. Terlipressin is an analogue of vasopressin with a longer half-life that can be administered by bolus injection. We have previously observed that hypertonic albumin improves resuscitation following controlled hemorrhage in piglets. The aim of the present study was to analyze whether the treatment with the combination of terlipressin and hypertonic albumin can produce better hemodynamic and tissular perfusion parameters than normal saline or hypertonic albumin alone at early stages of hemorrhagic shock in an infant animal model...
2015: PloS One
Keila Kazue Ida, Denise Aya Otsuki, Adolfo Toshiro Cotarelli Sasaki, Emilyn Silva Borges, Letícia Urbano Cardoso Castro, Talita Rojas Sanches, Maria-Heloisa Massola Shimizu, Lúcia Conceição Andrade, José-Otávio Costa Auler, Alex Dyson, Kenneth John Smith, Joel Avancini Rocha Filho, Luiz-Marcelo Sá Malbouisson
INTRODUCTION: We investigated whether treatment with terlipressin during recovery from hypotension due to haemorrhagic shock (HS) is effective to restore cerebral perfusion pressure (CPP) and brain tissue markers of water balance, oxidative stress and apoptosis. METHODS: In this randomised controlled study, animals undergoing HS (target mean arterial pressure (MAP) 40 mm Hg for 30 minutes) were randomized to receive lactated Ringer's solution (LR; n = 14; 3x volume bled), terlipressin (TERLI; n = 14; 2 mg bolus), no treatment (HAEMO group; n = 12) or sham (n = 6)...
December 2015: Critical Care: the Official Journal of the Critical Care Forum
Xudong Xiao, Yu Zhu, Danyang Zhen, Xiao Ming Chen, Wu Yue, Liangming Liu, Tao Li
Arginine vasopressin (AVP) and its analog, terlipressin (TP), were all demonstrated beneficial for septic shock. What advantages and disadvantages that AVP and TP have for septic shock as well as the mechanism, however, are not completely known. With cecal ligation and puncture-induced septic shock rats and lipopolysaccharide-induced septic shock rabbits, we systematically compared the beneficial and side effects of AVP and TP, in septic shock and the sex difference, and investigated their relationship to Rho kinase and calcium sensitivity...
May 15, 2015: Journal of Surgical Research
Valter Nilton Felix
BACKGROUND AND OBJECTIVES: The hemodynamic support of sepsis is now formulated trying to insert terlipressin as salvage drug in catecholamine resistant shock, justifying a broad critical analysis. CONTENTS: The analysis included hemodynamic therapies with defined specific goals and new recommendations for fluid resuscitation, vasopressor therapy, and inotropic therapy of septic in adult and pediatric patients. CONCLUSIONS: Terlipressin appears as a new but controversial alternative for vasopressor therapy in sepsis...
June 2006: Revista Brasileira de Terapia Intensiva
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