Bailey Dwight M, Chima Ranjit S, Tidmarsh George F, Williams Mark D
Division of Pediatric Critical Care Medicine, Levine Children's Hospital @ Atrium Health, Charlotte, NC.
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
Crit Care Explor. 2019 Aug 15;1(8):e0036. doi: 10.1097/CCE.0000000000000036. eCollection 2019 Aug.
Severe sepsis and septic shock continue to be an important problem in children, with hospital mortality rates for pediatric severe sepsis as high as 25%.
Two pediatric patients with septic shock requiring high dose vasopressors, who were treated with angiotensin II as part of an open-label study. Both patients had a significant increase in mean arterial pressure shortly after initiation of angiotensin II, with a reduction of the dose of catecholamines and vasopressin infusions. Serious adverse events reported were not attributable to angiotensin II by investigators. One patient survived, and one died related to progressive cerebral edema.
Angiotensin II may represent another therapeutic option for pediatric patients who remain hypotensive despite receiving fluids and standard vasopressor therapy and deserves further study.
严重脓毒症和脓毒性休克仍是儿童面临的一个重要问题，小儿严重脓毒症的医院死亡率高达25%。
两名患有脓毒性休克且需要高剂量血管升压药的儿科患者，作为开放标签研究的一部分接受了血管紧张素II治疗。两名患者在开始使用血管紧张素II后不久平均动脉压均显著升高，同时儿茶酚胺和血管加压素输注剂量减少。研究人员报告的严重不良事件并非由血管紧张素II引起。一名患者存活，另一名患者死于进行性脑水肿。
血管紧张素II可能是尽管接受了液体复苏和标准血管升压药治疗仍处于低血压状态的儿科患者的另一种治疗选择，值得进一步研究。
