PMID- 37711646
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20231129
IS  - 2639-8028 (Electronic)
IS  - 2639-8028 (Linking)
VI  - 5
IP  - 9
DP  - 2023 Sep
TI  - Utilization of Synthetic Human Angiotensin II for Catecholamine-Resistant 
      Vasodilatory Shock in Critically Ill Children: A Single-Center Retrospective Case 
      Series.
PG  - e0978
LID - 10.1097/CCE.0000000000000978 [doi]
LID - e0978
AB  - OBJECTIVES: To describe our institutional experience utilizing adjunctive 
      synthetic angiotensin II in critically ill children with catecholamine-resistant 
      vasodilatory shock (CRVS). DESIGN: Single-center, retrospective case series. 
      SETTING: PICU and cardiac ICU (CICU) at a large, quaternary children's hospital 
      in the United States. PATIENTS: Twenty-three pediatric patients with CRVS who 
      were prescribed synthetic angiotensin II at the discretion of bedside clinicians 
      from January 2018 to April 2023. INTERVENTIONS: None. MEASUREMENTS AND MAIN 
      RESULTS: Twenty-three patients (20 in PICU, 3 in CICU) with a median age of 10.4 
      years (interquartile range [IQR] 1.5-18.5) received angiotensin II over the study 
      period, 70% of whom died. At the time of angiotensin II initiation, 17 patients 
      (74%) were receiving one or more forms of extracorporeal therapy, and median 
      Pediatric Logistic Organ Dysfunction-2 Score-2 in the prior 24 hours was 9 (IQR 
      7-11). The median time between initiation of the first vasoactive agent and 
      angiotensin II was 127 hours (IQR 13-289), and the median total norepinephrine 
      equivalent (NED) at initiation was 0.65 mug/kg/min (IQR 0.36-0.78). The median 
      duration of therapy was 27 hours (IQR 4-68), and at each timepoint assessed, 
      patients had median improvement in NED and mean arterial pressure (MAP) with 
      treatment. Survivors initiated angiotensin II nearly 3 days earlier in vasoactive 
      course (91.5 hr vs 161 hr, p = 0.23), and had both greater reduction in NED (-75% 
      [IQR -96 to -50] vs +2.1% [IQR -55 to 33], p = 0.008) and greater increase in MAP 
      (+15 mm Hg [IQR 10-27] vs -1.5 mm Hg [IQR -27 to 18], p = 0.052) at angiotensin 
      II discontinuation. CONCLUSIONS: We demonstrate reduction in NED and improved MAP 
      following initiation of angiotensin II in critically ill children with CRVS. 
      Further prospective work is needed to examine optimal timing of angiotensin II 
      initiation, appropriate patient selection, and safety in this population.
CI  - Copyright (c) 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf 
      of the Society of Critical Care Medicine.
FAU - Tezel, Oguzhan
AU  - Tezel O
AD  - Department of Pediatrics, School of Medicine, Marmara University, Istanbul, 
      Turkey.
FAU - Hutson, Tamara K
AU  - Hutson TK
AD  - Division of Pharmacy, Cincinnati Children's Medical Center, Cincinnati, OH.
FAU - Gist, Katja M
AU  - Gist KM
AD  - Division of Cardiology, Cincinnati Children's Medical Center, Cincinnati, OH.
AD  - Department of Pediatrics, University of Cincinnati College of Medicine, 
      Cincinnati, OH.
FAU - Chima, Ranjit S
AU  - Chima RS
AD  - Department of Pediatrics, University of Cincinnati College of Medicine, 
      Cincinnati, OH.
AD  - Division of Critical Care Medicine, Cincinnati Children's Medical Center, 
      Cincinnati, OH.
FAU - Goldstein, Stuart L
AU  - Goldstein SL
AD  - Department of Pediatrics, University of Cincinnati College of Medicine, 
      Cincinnati, OH.
AD  - Division of Nephrology and Hypertension, Cincinnati Children's Medical Center, 
      Cincinnati, OH.
FAU - Stanski, Natalja L
AU  - Stanski NL
AD  - Department of Pediatrics, University of Cincinnati College of Medicine, 
      Cincinnati, OH.
AD  - Division of Critical Care Medicine, Cincinnati Children's Medical Center, 
      Cincinnati, OH.
LA  - eng
GR  - K23 GM151444/GM/NIGMS NIH HHS/United States
GR  - KL2 TR001426/TR/NCATS NIH HHS/United States
PT  - Journal Article
DEP - 20230912
PL  - United States
TA  - Crit Care Explor
JT  - Critical care explorations
JID - 101746347
PMC - PMC10499081
OTO - NOTNLM
OT  - angiotensin II
OT  - pediatrics
OT  - sepsis
OT  - shock
EDAT- 2023/09/15 06:43
MHDA- 2023/09/15 06:44
PMCR- 2023/09/12
CRDT- 2023/09/15 03:55
PHST- 2023/09/15 06:44 [medline]
PHST- 2023/09/15 06:43 [pubmed]
PHST- 2023/09/15 03:55 [entrez]
PHST- 2023/09/12 00:00 [pmc-release]
AID - 10.1097/CCE.0000000000000978 [doi]
PST - epublish
SO  - Crit Care Explor. 2023 Sep 12;5(9):e0978. doi: 10.1097/CCE.0000000000000978. 
      eCollection 2023 Sep.