Ischemic skin lesions as a complication of continuous vasopressin infusion in catecholamine-resistant vasodilatory shock: Incidence and risk factors*

Abstract

ISLs are a common complication during continuous AVP infusion in patients with catecholamine-resistant vasodilatory shock. The presence of septic shock and a history of peripheral arterial occlusive disease are independent risk factors for the development of ISL.

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016

“…An a priori defined subgroup analysis demonstrated improved survival among patients receiving <15 μg/min norepinephrine at randomization with the addition of vasopressin; however, the pretrial rationale for this stratification was based on exploring potential benefit in the population requiring ≥15 μg/min norepinephrine. Higher doses of vasopressin have been associated with cardiac, digital, and splanchnic ischemia and should be reserved for situations in which alternative vasopressors have failed [275]. In the VANISH trial, 409 patients with septic shock were randomized in a factorial (2 × 2) design to receive vasopressin with placebo or hydrocortisone, or norepinephrine with placebo or hydrocortisone.…”

Terlipressine Induced Rhabdomyolysis After Orthotopic Liver Transplantation

“…The use of terlipressin in the presence of low tissue oxygen levels may have led to ischemic complications [16]. Moreover, relative hypovolemia associated with early recovery after liver transplantation together with concomitant administration of steroids (as part of immunosuppression) may have enhanced terlipressin effect [14].…”

“…Sepsis related hypoperfusion, concomitant administration of catecholamines or steroids [14] and arterial catheterization [15] may act as additional risk factors. Although our patient was not obese, edema was present in the lower part of the body, stretching the skin of the abdomen and lower limbs and increasing the surface area for the microvascular blood supply.…”

Competing Priorities in the Brain Injured Patient: Dealing with the Unexpected

“…61 On the opposite end of the hemodynamic spectrum, one should always be cognizant of complications related to use of escalating doses of vasoactive agents, including phenomena such as tachyphylaxis 62 and the possibility of skin/limb ischemia due to high-dose vasopressor use. 63 Although the authors encourage the use of advanced hemodynamic monitoring (both invasive and non-invasive), there are many potential complications associated with both errors in hemodynamic data interpretation and iatrogenic injury related to invasive line placement. 64 Intra-hospital patient transfers (i.e., transport to operating room or imaging suite) carry its own set of complications, with serious adverse outcomes attributed to such transfers in over 30% of critically ill patients.…”