Recent developments in the pharmacologic approach to pediatric critical care.

PURPOSE OF REVIEW: There is new information supporting a resurgence of targeted use of older medications. These therapies include hydrocortisone and vasopressin. In addition to these older drugs, newer drugs, drotrecogin alpha (activated protein C) and activated factor VII concentrate (NovoSeven), have been used and may improve outcome in the treatment of critically ill patients. This review summarizes the recent experience of these agents in the adult and pediatric critically ill populations.

RECENT FINDINGS: Preliminary findings are encouraging in selected septic children and adults for human recombinant activated protein C and protein C concentrate. Plasma vasopressin levels in pediatric septic shock and their importance have not yet been adequately studied. Recent evidence supports physiologic replacement of corticosteroids in specific adult populations. Further investigations are warranted to establish the role of activated factor VIIa in the treatment of critically ill children.

SUMMARY: The limited experience of protein C manipulation in critically ill septic pediatric patients makes it difficult to define its role in their care. Although it has been associated with improved outcomes, its risk profile warrants judicious use. Further prospective pediatric clinical trials are needed to define the role of vasopressin in the treatment of pediatric shock and cardiac arrest. The role of corticosteroids in the treatment of septic shock in adults and children continues to be debated. Activated factor VIIa administration to adult and pediatric patients without primary bleeding disorders has been increasing. Further investigations are warranted to establish the role of activated factor VIIa in the treatment of critically ill children.