Evaluation of Vasopressor Dose and the Incidence of Pressure Injuries in Critically Ill Patients

Abstract

OBJECTIVE:To evaluate risk factors associated with vasopressor use and development of hospital-acquired pressure injuries (HAPIs). METHODS:The researchers conducted a retrospective chart review in a 12-bed medical ICU at a community hospital. A total of 123 patients who received a minimum of 24 hours of continuous vasopressor administration between January 2017 and January 2019 were included. The primary outcomes assessed were vasopressor dose and HAPI incidence, with a subgroup analysis based on type. Secondary outcomes included quantity of vasopressors, duration, mean arterial pressure, mechanical ventilation, time to injury, severity, and location. RESULTS:The overall incidence of HAPIs was 20.3%, with 17% incidence in the low-dose cohort and 22.4% in the high-dose cohort (P = .317). There were no differences in the subgroup analysis based on vasopressor type. The most common locations for injuries were the sacrum and coccyx, with the majority being stage 1 or 2 based on the National Pressure Injury Advisory Panel severity staging. No correlations were found between HAPI incidence and factors such as multiple vasopressors use, mechanical ventilation, mean arterial pressure, or duration of vasopressor administration. The documentation of time to injury was significantly shorter in the high-dose cohort compared with the low-dose cohort (157.58 vs 330.86 hours, P < .05). CONCLUSIONS:The incidence of HAPIs did not differ between the low-and high-dose vasopressor cohorts. However, patients who received higher doses of vasopressors had documented pressure injuries sooner than the low-dose cohort, emphasizing the importance of close monitoring for HAPIs in patients receiving vasopressors.

Incidence, prevalence and risk factors of device‐related pressure injuries in adult intensive care unit: A meta‐analysis of 10,084 patients from 11 countries

“…Vasopressors contain epinephrine, norepinephrine, post‐pituitary hormone and dopamine, etc., often used to improve mean arterial pressure by stimulating the constriction of peripheral blood vessels and strengthen tissue hypoperfusions and hypoxia of vital organs among critically ill patients 40 . This change has an adverse effect on the surrounding tissues due to less hemorheology in the surrounding tissue, significantly increasing the likelihood of stress injury 41 . Among adults treated in a medical‐surgical intensive care unit, the use of vasopressors was related to an increased risk of pressure injury, which was not explicitly evaluated on the Braden scale 42 .…”

“…40 This change has an adverse effect on the surrounding tissues due to less hemorheology in the surrounding tissue, significantly increasing the likelihood of stress injury. 41 Among adults treated in a medical-surgical intensive care unit, the use of vasopressors was related to an increased risk of pressure injury, which was not explicitly evaluated on the Braden scale. 42 The requirement for mechanical ventilation was found to be a risk factor for DRPIs.…”

Risk factors for medical device-related pressure injury in ICU patients: A systematic review and meta-analysis

“…Cox [62] highlighted a strong association between the use of vasopressors and the occurrence of PI, identifying vasopressors as a risk factor for PI in the general population. Furthermore, Holt et al [63] found that while the dose of vasopressor may not affect the incidence of HAPI, patients receiving high-dose vasopressor develop PI earlier than in low-dose cohorts.…”

Evaluation of the effectiveness of preventive nursing measures for pressure injuries in patients in the neurology intensive care unit

“…PU are one of the common complications in patients in neurology ICU[ 10 , 11 ], and their incidence is still high around the world[ 12 , 13 ]. Due to the severity of their condition and long-term bed rest[ 14 ], ICU patients are susceptible to external factors[ 15 ], leading to ischemic necrosis of the skin and underlying tissues[ 16 ], thus forming PU[ 17 ]. The occurrence of PU not only brings pain and discomfort to patients, but may also cause infection, prolong hospitalization, and even threaten life[ 18 ].…”