Synthetic Human Angiotensin II in Pediatric Patients With Vasodilatory Shock: A Report on Two Patients

Background: 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%. Case Summary: 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. Conclusions: Angiotensin II may represent another therapeutic option for pediatric patients who remain hypotensive despite receiving fluids and standard vasopressor therapy and deserves further study.