Ischemic skin lesions as a complication of continuous vasopressin infusion in catecholamine-resistant vasodilatory shock: incidence and risk factors.
OBJECTIVE
To report on the incidence and risk factors associated with the development of ischemic skin lesions (ISL) in critically ill patients with catecholamine-resistant vasodilatory shock treated with a continuous infusion of arginine-vasopressin (AVP).


METHODS
Retrospective analysis.


METHODS
Twelve-bed general and surgical intensive care unit in a university hospital.


METHODS
A total of 63 critically ill patients with catecholamine-resistant vasodilatory shock.


METHODS
Continuous AVP infusion.


RESULTS
Demographic, hemodynamic, laboratory data, and skin status were evaluated 24 hrs before and during AVP therapy (24 and 48 hrs). Patients were grouped according to development of new ISL during AVP therapy. A mixed-effects model was used to compare groups. A multiple logistic regression analysis was used to identify independent risk factors for the development of ISL. ISL developed in 19 of 63 patients (30.2%). Thirteen of 19 patients (68%) developed ISL in distal limbs, two patients (10.5%) developed ISL of the trunk, four patients (21%) developed ISL in distal limbs and in the trunk. Five patients (26%) had additional ischemia of the tongue. Body mass index, preexistent peripheral arterial occlusive disease, presence of septic shock, and norepinephrine requirements were significantly higher in patients developing ISL. ISL patients received significantly more units of fresh frozen plasma and thrombocyte concentrates than patients without ISL. Preexistent peripheral arterial occlusive disease and presence of septic shock were independently associated with the development of ISL during AVP therapy.


CONCLUSIONS
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.
Dünser
Martin W
MW
Department of Anesthesia and Critical Care Medicine, Leopold Franzens University of Innsbruck, Austria.
Mayr
Andreas J
AJ
Tür
Andreas
A
Pajk
Werner
W
Barbara
Friesenecker
F
Knotzer
Hans
H
Ulmer
Hanno
H
Hasibeder
Walter R
WR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001127:Arginine Vasopressin / Q000008:administration & dosage / Q000009:adverse effects*; D001157:Arterial Occlusive Diseases / Q000150:complications; D001317:Austria / Q000453:epidemiology; D015992:Body Mass Index; D004351:Drug Resistance; D005260:Female; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D007511:Ischemia / Q000139:chemically induced* / Q000453:epidemiology / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000150:complications; D009638:Norepinephrine / Q000008:administration & dosage / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D012769:Shock / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D012867:Skin / Q000098:blood supply*; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000009:adverse effects*
D014662:Vasoconstrictor Agents; D001127:Arginine Vasopressin; D009638:Norepinephrine