Journal article
Vasopressin in Pediatric Vasodilatory Shock: A Multicenter Randomized Controlled Trial
American journal of respiratory and critical care medicine, Vol.180(7), pp.632-639
2009
DOI: 10.1164/rccm.200902-0221OC
PMID: 19608718
Abstract
Rationale: Vasopressin has been proposed as a potent vasoactive agent in the treatment of vasodilatory shock in adults and children. The objective of this trial was to evaluate the efficacy and safety of vasopressin as an adjunctive agent in pediatric vasodilatory shock.
Methods: In this multicenter, double-blind trial, children with vasodilatory shock were randomized to receive low-dose vasopressin (0.0005–0.002 U/kg/min) or placebo in addition to open-label vasoactive agents. Vasoactive infusions were titrated to clinical endpoints of adequate perfusion. The primary outcome was time to vasoactive-free hemodynamic stability. Secondary outcomes included mortality, organ-failure–free days, length of critical care unit stay, and adverse events.
Measurements and Main Results: Sixty-five of 69 children (94%) who were randomized received the study drug (33 vasopressin, 32 placebo) and were included in the analysis. There was no significant difference in the primary outcome between the vasopressin and placebo groups (49.7 vs. 47.1 hours; P = 0.85). There were 10 deaths (30%) in the vasopressin group and five (15.6%) in the placebo group (relative risk, 1.94; 95% confidence interval, 0.75–5.05; P = 0.24). There were no significant differences with respect to organ failure–free days (22 vs. 25.5 days; P = 0.11), ventilator-free days (16.5 23 days; P = 0.15), length of stay (8 vs. 8.5 days; P = 0.93), or adverse event rate ratios (12.0%; 95% confidence interval, −2.6 to 26.7; P = 0.15).
Conclusions: Low-dose vasopressin did not demonstrate any beneficial effects in this pediatric trial. Although not statistically significant, there was a concerning trend toward increased mortality.
Details
- Title: Subtitle
- Vasopressin in Pediatric Vasodilatory Shock: A Multicenter Randomized Controlled Trial
- Creators
- Karen CHOONG - Department of Pediatrics and Critical Care, McMaster Children's Hospital, Hamilton, Ontario, CanadaDesmond BOHN - Department of Critical Care and Division of Neonatology, Department of Pediatrics, the Hospital for Sick Children, Ontario, CanadaDouglas D FRASER - Department of Pediatrics and Critical Care, Children's Hospital of Western Ontario, London, Ontario, CanadaIsabelle GABOURY - Children's Hospital of Eastern Ontario Research Institute, Ottawa, CanadaJames S HUTCHISON - Department of Critical Care and Division of Neonatology, Department of Pediatrics, the Hospital for Sick Children, Ontario, CanadaAri R JOFFE - Division of Pediatric Critical Care, Department of Pediatrics and Critical Care, Stollery Children's Hospital, Edmonton, Alberta, CanadaCatherine LITALIEN - Division of Critical Care, Department of Pediatrics, CHU Ste-Justine, Montreal, Quebec, CanadaKusum MENON - Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, CanadaPatrick MCNAMARA - Department of Critical Care and Division of Neonatology, Department of Pediatrics, the Hospital for Sick Children, Ontario, CanadaRoxanne E WARD - Children's Hospital of Eastern Ontario Research Institute, Ottawa, CanadaCanadian Critical Care Trials Group
- Resource Type
- Journal article
- Publication Details
- American journal of respiratory and critical care medicine, Vol.180(7), pp.632-639
- Publisher
- American Thoracic Society
- DOI
- 10.1164/rccm.200902-0221OC
- PMID
- 19608718
- ISSN
- 1073-449X
- eISSN
- 1535-4970
- Language
- English
- Date published
- 2009
- Academic Unit
- Stead Family Department of Pediatrics; Neonatology; Internal Medicine
- Record Identifier
- 9984093493002771
Metrics
12 Record Views