Terlipressin for norepinephrine-resistant septic shock

  title={Terlipressin for norepinephrine-resistant septic shock},
  author={Alastair J O'Brien and Lucie H. Clapp and Mervyn Singer},
  journal={The Lancet},

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Terlipressin for catecholamine-resistant septic shock in children

Terlipressin might be considered, at least as a rescue therapy, for hypotension resistant to catecholamines in children with septic shock, and the optimal administration schedule remains to be elucidated.

Terlipressin Infusion in Catecholamine-resistant Shock

A case report is described where the use of a continuous terlipressin infusion was associated with a dramatic improvement in the treatment of catecholamine-resistant shock.


It is concluded that terlipressin improves hemodynamic indices and renal function in critically ill children and should be considered as a rescue therapy in intractable shock not responsive to catecholamines in children.

Role of vasopressin in the management of septic shock

Vasopressin causes arterial smooth muscle cell contraction through a non-catecholamine receptor pathway, thus it represents an attractive adjunct to the management of septic shock, especially when catecholamines are ineffective.

"Terlipressin in the treatment of septic shock: the earlier the better"?

Clinical review: Vasopressin and terlipressin in septic shock patients

Vasopressin (antidiuretic hormone) is emerging as a potentially major advance in the treatment of septic shock, and terlipressin is the synthetic, long-acting analogue of vasopress in which this drug has been used in far fewer patients.

Terlipressin bolus induces systemic vasoconstriction in septic shock*

  • M. PetersR. BoothA. Petros
  • Medicine
    Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
  • 2004
Tropical terlipressin may be useful for sepsis-induced vasodilation and associated with a rapid increase in systemic vascular resistance, despite weaning and discontinuation of norepinephrine infusion.

Terlipressin as rescue treatment of refractory shock in a neonate

A neonate with systemic inflammatory response syndrome after surgery for abdominal neuroblastoma who received terlipressin as rescue treatment after failure of volume load and catecholamines promptly reversed hypotension and improved tissue perfusion without adverse effects is reported.

Current place of vasopressin analogues in the treatment of septic shock

Current literature suggests that early infusion of low-dose continuous arginine vasopressin or terlipressin appears superior to a last-resort treatment, however, because no large clinical trials have proven ter Lipressin’s safety in patients with septic shock, arginines vasopressingin is preferred until more data are available.



Low-dose vasopressin in the treatment of vasodilatory septic shock.

A VP infusion improved arterial pressure and permitted the withdrawal of catecholamine vasopressors and is a useful agent in the treatment of refractory septic shock.

Vasopressin deficiency contributes to the vasodilation of septic shock.

Vasopressin plasma levels are inappropriately low in vasodilatory shock, most likely because of impaired baroreflex-mediated secretion.

Hemodynamic and metabolic effects of low-dose vasopressin infusions in vasodilatory septic shock

Low-dose vasopressin infusions increased mean arterial pressure, systemic vascular resistance, and urine output in patients with vasodilatory septic shock and hyporesponsiveness to catecholamines, and the data indicate that low-dose vascular resistance infusions may be useful in treating hypotension in these patients.

Vasopressin deficiency contributes to the vasodilation of septic shock.

Landry et al clearly show that vasopressin plasma levels are inappropriately low in septic shock and that this deficiency contributes to the hypotension of vasodilatory septicshock.

The effects of vasopressin on endotoxin-induced attenuation of contractile responses in human gastroepiploic arteries in vitro.

The results of this study suggest that, in addition to its direct vasoconstrictor effect, vasopressin strongly enhances the responses to norepinephrine through V1-receptor stimulation and that vasopressingin could find a role in the management of endotoxin-induced vasodilation.

Potentiation by vasopressin of adrenergic vasoconstriction in the rat isolated mesenteric artery

It is demonstrated that low concentrations of vasopressin strongly potentiate the contractions to adrenergic stimulation and KCl depolarization.

Pathogenesis of upper airway occlusion during sleep

Ten patients with daytime somnolence and obesity were found to have periodic airway occlusion (AO) during nocturnal sleep, and it is speculated that genioglossal force act,s to open the oropharynx and that negative pharyngeal pressure promotes pharynGEal closure.

Upper airway pressure-flow relationships in obstructive sleep apnea.

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The effect of sleep on reflex genioglossus muscle activation by stimuli of negative airway pressure in humans.

It is shown that non‐REM sleep attenuates reflex genioglossus muscle activation by stimuli of negative airway pressure, which may have implications for the pathogenesis of obstructive sleep apnoea.