Vasopressors and Pressure Injury Risk in the Critically Ill

Abstract

We have not done any further analysis; therefore, we still do not know the exact etiological factor (vasopressor vs shock sequelae vs overall severity of illness) that places the patient at increased risk for PI. We strongly suspect that vasopressors and especially vasopressin play a significant role in PI development. Although we know that cutaneous manifestations associated with vasopressor medications exist, the evidence is not strong as to whether the associated gangrene is related to vasopressors or to the sequelae of shock that the vasopressors were administered to treat.When patients are receiving vasopressors, PI interventions such as more frequent repositioning or small repositioning shifts may be indicated, depending on the support surface in use and the patient’s individual tissue tolerance. For example, in patients with anasarca, tissue tolerance is severely compromised and increased frequency of repositioning/off-loading may be necessary. The use of prophylactic multilayer silicone foam dressings, if they are not already in use, should be considered as well.Interestingly, in the International Pressure Injury Guidelines published in 2019, skin temperature is mentioned as a potential PI risk factor because it can affect tissue tolerance to mechanical loads. In addition, patients who are diaphoretic may be more susceptible to pressure.Lateral rotation should not be used for repositioning patients because the lateral movement can actually increase shear and thus increase PI risk. Foam wedges are effective if you can use them to off-load pressure adequately. Pillows can be effective, as well, as long as these devices are used to prop the patient in a 30° side-lying position.