Terlipressin facilitates transport of septic patients treated with norepinephrine.

Recently, terlipressin, a long-acting vasopressin analogue, was successfully used to provide hemodynamic support in adult patients with catecholamine-resistant septic shock. That report concluded with the recommendation that terlipressin be used in patients with norepinephrine-resistant septic shock (2). No study has demonstrated the efficacy and safety of terlipressin in the treatment of septic unstable patients who needed to be transported outside the intensive care unit. In the present paper we present the results of a retrospective review of our experience over a 4 year period in administering terlipressin to septic shock patients who needed to be transported. Abstract Background: Transport of hemodynamic unstable septic patients for diagnostic or therapeutic interventions outside the intensive care unit is complex but sometimes contributes to increasing the chance of survival. Objectives: To report our experience with terlipressin treatment for facilitation of transport to distant facilities for diagnostic or therapeutic procedures in septic patients treated with norepinephrine. Methods: We conducted a retrospective analysis of the records of our ICU, identifying the patients with septic shock who required norepinephrine for hemodynamic support. Results: Terlipressin was given to 30 septic shock patients (15 females and 15 males) who were on high dose norepinephrine (10 μg/min or more) in order to facilitate their transport outside the ICU. The dose of terlipressin ranged from 1 to 4 mg, with a mean of 2.13 ± 0.68 mg. The dose of norepinephrine needed to maintain systolic blood pressure above 100 mmHg decreased following terlipressin administration, from 21.9 ± 10.4 μg/min (range 5-52 μg/min) to 1.0 ± 1.95 (range 0-10) (P < 0.001). No patients required norepinephrine dose adjustment during transport. No serious complications or overshoot in blood pressure values were observed following terlipressin administration. Acrocyanosis occurred only in eight patients receiving more than 1 mg of the drug. The overall mortality rate was 50%. Conclusions: Our data suggest that terlipressin is effective in septic shock. Because it is long-acting and necessitates less titration it might be indicated for patient transportation.