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Curr Opin Crit Care 2019 Jun;25(3):246-251

Director Acute Respiratory Intensive Care Unit, Emory University Hospital, Atlanta, USA.

Purpose Of Review: Shock, best defined as acute circulatory failure is classified into four major groups, namely hypovolemic, cardiogenic, obstructive, and distributive (vasodilatory). The purpose of this review is to provide a practical approach to fluid optimization in patients with the four types of shock.

Recent Findings: Large-volume fluid resuscitation has traditionally been regarded as the cornerstone of resuscitation of shocked patients. Read More

Circ Cardiovasc Qual Outcomes 2019 Mar;12(3):e005618

Levine Cardiac Intensive Care Unit, TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.D.B, E.A.B., V.M.B.-Z., J.-G.P., D.A.M.).

Background Clinical investigations of shock in cardiac intensive care units (CICUs) have primarily focused on acute myocardial infarction (AMI) complicated by cardiogenic shock (AMICS). Few studies have evaluated the full spectrum of shock in contemporary CICUs. Methods and Results The Critical Care Cardiology Trials Network is a multicenter network of advanced CICUs in North America. Read More

Prehosp Emerg Care 2019 Mar 15:1-8. Epub 2019 Mar 15.

Objective: Hypotension in the prehospital environment is common and linked to dose-dependent mortality. Bolus dose epinephrine (BDE) may reverse hypotension. We tested if BDE use to treat profound hypotension is associated with 24-hour survival. Read More

Am J Cardiovasc Drugs 2019 04;19(2):227

Division of Cardiovascular and Renal Products, Center for Drug Evaluation and Research, Food and Drug Administration, 10903 New Hampshire Ave, Bldg 22, Room #4128, Silver Spring, MD, USA.

The author name that previously read. Read More

BMJ Case Rep 2019 Feb 13;12(2). Epub 2019 Feb 13.

Department of General Medicine, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.

A 27-year-old man presented with high-grade intermittent fever for 4 months, generalised fatigue for 2 months, intermittent gum bleeds for 1 month and loss of weight of 15 kg. He appeared cachectic with generalised wasting, had pallor and features of reticuloendothelial system proliferation. His liver span was 17 cm. Read More

Cureus 2018 Nov 30;10(11):e3665. Epub 2018 Nov 30.

Surgery, Riverside Community Hospital / University of California, Riverside, USA.

Distributive (vasodilatory) shock is common in patients admitted to the intensive care unit (ICU). Treating distributive shock presents a challenge, especially if a patient is tachyphylactic to commonly used vasopressors. This case report illustrates the use of a newly approved vasopressor in a patient with vasodilatory shock resulting from a motor vehicle injury. Read More

Cardiol Rev 2019 May/Jun;27(3):167-169

Einstein Division, Bronx, NY.

Septic shock, a form of vasodilatory shock associated with high morbidity and mortality, requires early and effective therapy to improve patient outcomes. Current management of septic shock includes the use of intravenous fluids, catecholamines, and vasopressin for hemodynamic support to ensure adequate perfusion. Despite these interventions, hospital mortality rates are still greater than 40%. Read More

Med Hypotheses 2019 Jan 22;122:35-40. Epub 2018 Oct 22.

Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Pathology Department, Meir Medical Center, Kfar Saba, Israel.

Background: Sudden Infant Death Syndrome (SIDS) mechanisms of death remains obscured. SIDS' Triple Risk Model assumed coexistence of individual subtle vulnerability, critical developmental period and stressors. Prone sleeping is a major risk factor but provide no clues regarding the mechanism of death. Read More

Dtsch Arztebl Int 2018 11;115(45):757-768

Department of Anesthesiology, Intensive and Palliative Care Medicine, Städtisches Klinikum Solingen gGmbH; Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne; Institute of Clinical and Experimental Pharmacology at the University Medical Center Schleswig-Holstein, Campus Kiel; Surgical Center/Emergency Department, Department of Anesthesiology and Intensive Care, University; Hospital Carl Gustav Carus, Technische Universität Dresden; Department of Cardiothoracic Surgery, Cardiac Center, University Hospital of Cologne; Department of Orthopedics and Trauma Surgery, Kath. Krankenhaus Hagen gGmbH.

Background: A severe mismatch between the supply and demand of oxygen is the common feature of all types of shock. We present a newly developed, clinically oriented classification of the various types of shock and their therapeutic implications.

Methods: This review is based on pertinent publications (1990-2018) retrieved by a selective search in PubMed, and on the relevant guidelines and meta-analyses. Read More

Ann Emerg Med 2018 Nov 13. Epub 2018 Nov 13.

Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN.

Surgery 2019 Jan 8;165(1):158-165. Epub 2018 Nov 8.

Division of Surgical Oncology, Oregon Health & Science University, Portland. Electronic address:

Background: Sudden massive release of serotonin, histamine, kallikrein, and bradykinin is postulated to cause an intraoperative carcinoid crisis. The exact roles of each of these possible agents, however, remain unknown. Optimal treatment will require an improved understanding of the pathophysiology of the carcinoid crisis. Read More

Ann Intensive Care 2018 Nov 8;8(1):107. Epub 2018 Nov 8.

Division of Critical Care Medicine, St. Paul's Hospital, Vancouver, BC, V6Z 1Y6, Canada.

Background: Maintenance of mean arterial pressure (MAP) at levels sufficient to avoid tissue hypoperfusion is a key tenet in the management of distributive shock. We hypothesized that patients with distributive shock sometimes have a MAP below that typically recommended and that such hypotension is associated with increased mortality.

Methods: In this retrospective analysis of the Medical Information Mart for Intensive Care (MIMIC-III) database from Beth Israel Deaconess Medical Center, Boston, USA, we included all intensive care unit (ICU) admissions between 2001 and 2012 with distributive shock, defined as continuous vasopressor support for ≥ 6 h and no evidence of low cardiac output shock. Read More

P T 2018 Nov;43(11):685-687

The approval of synthetic human angiotensin II (Giapreza, LaJolla Pharmaceuticals) by the FDA in December 2017 provides clinicians with a new tool in the treatment of distributive shock. Angiotensin II (ATII) was approved based on the results of the ATHOS-3 trial. In this trial, patients who received angiotensin II were more likely to achieve a mean arterial pressure of 75 mmHg or an increase in mean arterial pressure of 10 mmHg above that seen in patients who received a placebo. Read More

Prehosp Disaster Med 2018 Dec 9;33(6):668-672. Epub 2018 Nov 9.

Department of Emergency Medicine,Navy Medical Center Portsmouth,Portsmouth,VirginiaUSA.

IntroductionEmergency physicians are using bolus-dose vasopressors to temporize hypotensive patients until more definitive blood pressure support can be established. Despite a paucity of clinical outcome data, emergency department applications are expanding into the prehospital setting. This series presents two cases of field expedient vasopressor use by emergency medicine providers for preflight stabilization during aeromedical evacuation to a hospital ship as part of the United States Navy disaster response in Puerto Rico. Read More

Crit Care Med 2019 Jan;47(1):e44-e51

Intensive Care Unit, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil.

Objectives: To systematically review the literature and synthesize evidence concerning the effects of vasopressin and its analogs compared with other vasopressors in distributive shock, focusing on renal outcomes.

Data Sources: We performed a systematic review in MEDLINE, Embase, Cochrane Central, and Clinicaltrials.gov databases. Read More

Curr Opin Crit Care 2018 Dec;24(6):512-518

Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

Purpose Of Review: Intravenous fluid administration is a fundamental therapy in critical care, yet key questions remain unanswered regarding optimal fluid composition and dose. This review evaluates recent evidence regarding the effects of fluid resuscitation on pathophysiology, organ function, and clinical outcomes for critically ill patients.

Recent Findings: Recent findings suggest that intravenous fluid composition affects risk of kidney injury and death for critically ill adults. Read More

J Med Case Rep 2018 Sep 13;12(1):259. Epub 2018 Sep 13.

Department of Emergency and Critical Care Medicine, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.

Background: Early dumping syndrome characterized by palpitation, dizziness, cold sweat, feebleness, and abdominal symptoms, occurs within 30 minutes after meals in patients who have undergone gastrectomy. This case report describes the case of a patient who presented with severe distributive shock due to early dumping syndrome; he recovered within a few hours after massive fluid infusion and vasopressor administration.

Case Presentation: Our patient was a 68-year-old Japanese man who underwent total gastrectomy for gastric cancer and was diagnosed as having late dumping syndrome. Read More

Am J Cardiovasc Drugs 2019 02;19(1):11-20

Division of Cardiovascular and Renal Products, Center for Drug Evaluation and Research, Food and Drug Administration, 10903 New Hampshire Ave, Bldg 22, Room #4128, Silver Spring, MD, USA.

Distributive shock is a subset of shock marked by decreased systemic vascular resistance, organ hypoperfusion and altered oxygen extraction. Despite the use of intravenous fluids and either higher dose of catecholamines or other additional exogenous vasopressors to maintain blood pressure in the target range, the rate of mortality remains higher in patients with septic shock. Therefore, there is clearly an unmet need for additional safe and effective treatments. Read More

South Med J 2018 07;111(7):373-381

From the Departments of Emergency Medicine and Internal Medicine, Greenville Health System, University of South Carolina School of Medicine, Greenville, the Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of South Carolina School of Medicine, Columbia, and the Department of Medicine, Division of General and Hospital Medicine, University of Texas Health, San Antonio.

The original and most widely accepted applications for point-of-care ultrasound (POCUS) are in the settings of trauma, shock, and bedside procedures. Trauma was the original setting for the introduction of POCUS and has been standardized under the four-plus view examination called the Focused Assessment with Sonography in Trauma (FAST). This examination was found to be especially practice changing for achieving rapid diagnoses in critically ill patients who are too unstable for the delays and transportation inherent in more advanced imaging with computed tomography. Read More

Crit Care 2018 06 15;22(1):162. Epub 2018 Jun 15.

Center for Acute Respiratory Failure, Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians & Surgeons, 622 W. 168th Street, 8E101, New York, NY, 10032, USA.

Background: Post-resuscitation hemodynamic instability following out-of-hospital cardiac arrest (OHCA) may occur from myocardial dysfunction underlying cardiogenic shock and/or inflammation-mediated distributive shock. Distinguishing the predominant shock subtype with widely available clinical metrics may have prognostic and therapeutic value.

Methods: A two-hospital cohort was assembled of patients in shock following OHCA. Read More

JAMA 2018 05;319(18):1889-1900

McMaster University, Hamilton, Ontario, Canada.

Importance: Vasopressin is an alternative to catecholamine vasopressors for patients with distributive shock-a condition due to excessive vasodilation, most frequently from severe infection. Blood pressure support with a noncatecholamine vasopressor may reduce stimulation of adrenergic receptors and decrease myocardial oxygen demand. Atrial fibrillation is common with catecholamines and is associated with adverse events, including mortality and increased length of stay (LOS). Read More

Perfusion 2018 11 22;33(8):704-706. Epub 2018 May 22.

1 Department of Anesthesiology, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI, USA.

We describe the case of a 4-year-old male with a past medical history significant for nephrotic syndrome, short-bowel syndrome and fulminant hepatic failure status post (s/p) liver transplant (LT) who developed early post-transplant allograft dysfunction (hyperbilirubinemia, coagulopathy) and septic shock requiring central extracorporeal membrane oxygenation (ECMO). He remained on ECMO for 85 hours before he was decannulated without event and later underwent repeat LT. This case highlights the potential of central ECMO to provide the circulatory output necessary to reverse distributive shock physiology in patients with sepsis and hepatic dysfunction following LT. Read More

Chin J Traumatol 2018 Jun 26;21(3):156-162. Epub 2018 Mar 26.

Department of Anesthesia and Intensive Care, Faculty of Medicine, Suez Canal University, Egypt.

Purpose: "Polytrauma" patients are of a higher risk of complications and death than the summation of expected mortality and morbidity of their individual injuries. The ideal goal in trauma resuscitation care is to identify and treat all injuries. With clinical and technological advanced imaging available for diagnosis and treatment of traumatic patients, point of care-rapid ultrasound in shock and hypotension (RUSH) significantly affects modern trauma services and patient outcomes. Read More

Heart Lung 2018 Jul - Aug;47(4):425-428. Epub 2018 May 18.

Department of Allergy, Immunology, Respiratory Medicine, The Alfred Hospital, Commercial Road, Prahran, Melbourne, VIC 3181, Australia.

Background: Idiopathic capillary leak syndrome (Clarkson's Disease) is a rare angiopathy with a heterogenous phenotype that may present as distributive shock refractory to resuscitative management.

Objective: We report a case of idiopathic systemic capillary leak syndrome presenting as septic shock.

Methods: Structured case report and review of the literature. Read More

Masui 2017 May;66(5):484-492

Patients with cardiac disease have high mortality rates, mainly owing to shock. Therefore, evaluation of cardiac function is one of the most challenging issues in the intensive and critical care unit. Cardiac point-of-care tests using ultrasound, such as focus assessed transthoracic echo (FATE) and rapid ultrasound in shock (RUSH). Read More

Br J Nurs 2018 Apr;27(8):449-454

Assistant Teacher, Portuguese Catholic University, Lisbon, Portugal.

Background: shock refers to a physiological situation that puts life at risk. Its early identification and the timely institution of therapeutic measures can avoid death. Despite the frequent administration of fluid therapy as a treatment for shock, the type and dose of fluids to be delivered remain undetermined. Read More

Emerg Med Clin North Am 2018 May 10;36(2):427-440. Epub 2018 Feb 10.

Pediatrics, Division of Pediatric Critical Care Medicine, University of Arizona College of Medicine, Banner-University Medical Center, 1501 North Campbell Avenue, PO Box 245073, Tucson, AZ 85724-5073, USA; Emergency Medicine, University of Arizona College of Medicine, Banner-University Medical Center, 1501 North Campbell Avenue, Tucson, AZ 85724-5073, USA. Electronic address:

Shock, a state of inadequate oxygen delivery to tissues resulting in anaerobic metabolism, lactate accumulation, and end-organ dysfunction, is common in children in emergency department. Shock can be divided into 4 categories: hypovolemic, distributive, cardiogenic, and obstructive. Early recognition of shock can be made with close attention to historical clues, physical examination and vital sign abnormalities. Read More

Front Vet Sci 2018 16;5:53. Epub 2018 Mar 16.

QTest Labs, Columbus, OH, United States.

Although the utility and benefits of anesthesia and analgesia are irrefutable, their practice is not void of risks. Almost all drugs that produce anesthesia endanger cardiovascular stability by producing dose-dependent impairment of cardiac function, vascular reactivity, and compensatory autoregulatory responses. Whereas anesthesia-related depression of cardiac performance and arterial vasodilation are well recognized adverse effects contributing to anesthetic risk, far less emphasis has been placed on effects impacting venous physiology and venous return. Read More

Ann Pharmacother 2018 Sep 27;52(9):920-927. Epub 2018 Mar 27.

1 University of Kentucky Medical Center, Lexington, KY, USA.

Objective: To review and summarize data on angiotensin II (AT-II), approved by the Food and Drug Administration (FDA) in December 2017 to increase blood pressure in adults with septic or other distributive shock.

Data Sources: A PubMed/MEDLINE search was conducted using the following terms: (angiotensin ii OR angiotensin 2) AND (shock) from 1966 to February 2018.

Study Selection And Data Extraction: A total of 691 citations were reviewed with only relevant clinical data extracted. Read More

P T 2018 Mar;43(3):141-170

Zoster vaccine recombinant, adjuvanted (Shingrix) for the prevention of shingles in adults; angiotensin II injection (Giapreza) to increase blood pressure in adults with septic or other distributive shock; and glycopyrrolate inhalation solution (Lonhala Magnair) for the maintenance treatment of chronic obstructive pulmonary disease. Read More

CEN Case Rep 2018 May 17;7(1):110-113. Epub 2018 Jan 17.

Nephrology Department, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Calle Vasco de Quiroga 15, Tlalpan, Sección XVI, 14000, Mexico City, Mexico.

We report a case of capillary leak that developed during treatment of antibody-mediated rejection in a kidney transplant recipient. A 53-year-old female transplant recipient experienced an increase in serum creatinine from 1.1 to 1. Read More

Crit Care 2017 Dec 28;21(1):324. Epub 2017 Dec 28.

Department of Critical Care, King's College London, Guy's & St Thomas' NHS Foundation Hospital, London, SE1 7EH, UK.

Background: Circulatory shock is a common syndrome with a high mortality and limited therapeutic options. Despite its discovery and use in clinical and experimental settings more than a half-century ago, angiotensin II (Ang II) has only been recently evaluated as a vasopressor in distributive shock. We examined existing literature for associations between Ang II and the resolution of circulatory shock. Read More

J Neurotrauma 2018 02 18;35(3):461-466. Epub 2017 Dec 18.

1 International Collaboration on Repair Discoveries, University of British Columbia , Vancouver, British Columbia, Canada .

Neurogenic shock, a distributive type of circulatory shock after spinal cord injury (SCI), results in profound hypotension. The consequent hemodynamic instability complicates clinical management, delays surgical intervention, and impacts neurological outcome. Moreover, the reported incidence of this condition varies significantly. Read More

J Emerg Med 2018 Jan 27;54(1):e1-e3. Epub 2017 Oct 27.

Childrens Hospital of Michigan, Detroit, Michigan.

Background: Hemangiomas are common cutaneous findings on healthy infants. These vascular malformations are generally benign, though in rare circumstances they can potentially be fatal. This is particularly true when the hemangiomas are large or numerous and occurring in visceral organs. Read More

J Gastrointestin Liver Dis 2017 06;26(2):183-187

Division of Gastroenterology, Department of Medicine Washington University School of Medicine, St. Louis, MO, USA.

Background: Non-Langerhans histiocytosis is a group of inflammatory lymphoproliferative disorders originating from non-clonal expansion of hematopoietic stem cells into cytokine-secreting dendritic cells or macrophages. Erdheim-Chester Disease (ECD) is a rare type of non-Langerhans cell histiocytosis characterized by tissue inflammation and injury caused by macrophage infiltration and histologic findings of foamy histiocytes. Often ECD involves the skeleton, retroperitoneum and the orbits. Read More

MedEdPORTAL 2017 Jun 7;13:10591. Epub 2017 Jun 7.

Associate Professor, Department of Biomedical Sciences, Western Michigan University Homer Stryker MD School of Medicine.

Introduction: This multipatient simulation exercise was designed for second-year medical students to illustrate the four different categories of shock (hypovolemic, cardiogenic, obstructive, distributive) during a single simulation session. The comparative design of this simulation was intended to help students develop a conceptual framework for diagnosing and treating each type of shock.

Methods: Students worked together in teams of five under specified time constraints to solve six simulated shock cases. Read More

Shock 2018 Jan;49(1):99-107

The Critical Care Research Group, Chermside, Brisbane, Australia.

Background: Animal models of endotoxemia are frequently used to understand the pathophysiology of sepsis and test new therapies. However, important differences exist between commonly used experimental models of endotoxemia and clinical sepsis. Animal models of endotoxemia frequently produce hypodynamic shock in contrast to clinical hyperdynamic shock. Read More

Eur Heart J Acute Cardiovasc Care 2018 Oct 27;7(7):624-630. Epub 2017 Mar 27.

3 Intensive Care Unit, Nicosia General Hospital, Cyprus.

Kounis syndrome is defined as the coincidental occurrence of an acute coronary syndrome with hypersensitivity reactions following an allergic event. The three reported variants of Kounis syndrome are vasospastic allergic angina, allergic myocardial infarction and stent thrombosis with occluding thrombus. The syndrome is caused by various inflammatory mediators. Read More

Case Rep Cardiol 2017 5;2017:8407530. Epub 2017 Feb 5.

Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.

Cardiac dysfunction is a common complication of sepsis in individuals with preexisting coronary disease and portends a poor prognosis when progressing to ischemic cardiogenic shock. In this setting, maximal medical therapy in isolation is often inadequate to maintain cardiac output for patients who are poor candidates for immediate revascularization. Furthermore, the use of vasopressors and inotropes increases myocardial demand and may lead to further injury. Read More

J Emerg Med 2017 Jun 21;52(6):e229-e231. Epub 2017 Feb 21.

Department of Emergency Medicine, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey.

Background: Distributive shock is a hyperdynamic process resulting from excessive vasodilatation. Impaired blood flow causes inadequate tissue perfusion, which can lead to end-organ damage. Although the most common etiology is septic shock, anaphylactic and other etiologies should be considered. Read More

Chin Med Sci J 2016 Mar;31(1):37-42

Department of Critical Care Medicine, Cancer Hospital and Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, 100021 Beijing, China.

Objective To investigate the respiratory and cardiac characteristics of elderly Intensive Care Unit (ICU) patients.Methods Twelve senior ICU patients aged 90 years and older were enrolled in this study. We retrospectively collected all patients' clinical data through medical record review. Read More

Shock 2019 Jan;51(1):60-67

Department of Emergency Medicine, Odense University Hospital, Odense C, Denmark.

Introduction: The knowledge of the etiology and associated mortality of undifferentiated shock in the emergency department (ED) is limited. We aimed to describe the etiology-based proportions and incidence rates (IR) of shock, as well as the associated mortality in the ED.

Methods: Population-based cohort study at a University Hospital ED in Denmark from January 1, 2000, to December 31, 2011. Read More

Best Pract Res Clin Anaesthesiol 2016 Dec 5;30(4):465-477. Epub 2016 Nov 5.

Department of Anaesthesiology, University Hospital of Greifswald, Greifswald, Germany. Electronic address:

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. Read More

A A Case Rep 2017 Feb;8(3):51-54

From the *Division of Anesthesiology, Antonio Pedro University Hospital, Fluminense Federal University, Niterói, Brazil; and †Department of Surgery, Fluminense Federal University Medical School, Niterói, Brazil.

Mesenteric traction syndrome is defined as arterial hypotension, facial flushing, and tachycardia related to mesenteric traction. We describe a case of mesenteric traction syndrome refractory to catecholamine and vasopressin infusions. The patient, who had Crohn disease, developed severe distributive shock after mesenteric traction while undergoing resection of an intestinal inflammatory mass, accompanied by facial flushing and unaltered readings for pulse oximetry, capnography, and bispectral index monitoring. Read More

Expert Rev Anti Infect Ther 2017 01 7;15(1):5-10. Epub 2016 Nov 7.

b Service d'Anesthésie et de Réanimation , Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix Marseille Université , Marseille , France.

Introduction: Distributive shock is associated with decreased systemic vascular resistance and altered oxygen extraction. Septic shock is the most frequent form of distributive shock. In shock states, duration of hypotension is associated with poor outcomes. Read More

Paediatr Drugs 2017 Feb;19(1):35-41

Department of Pediatric Cardiology, Pulmology and Pediatric Intensive Care Medicine, University Children's Hospital, Hoppe-Seyler-Str. 1, 72076, Tuebingen, Germany.

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. Read More