title: Vasopressors and development of pressure ulcers in adult critical care patients.
abstract: BACKGROUND
  Vasopressors are lifesaving agents used to raise mean arterial pressure in critically ill patients in shock states. The pharmacodynamics of these agents suggest vasopressors may play a role in development of pressure ulcers; however, this aspect has been understudied.
  
  
  OBJECTIVE
  To examine associations between type, dose, and duration of vasopressors (norepinephrine, epinephrine, vasopressin, phenylephrine, dopamine) and development of pressure ulcers in medical-surgical and cardiothoracic intensive care unit patients and to examine predictors of the development of pressure ulcers in these patients.
  
  
  METHODS
  A retrospective correlational design was used in a sample of 306 medical-surgical and cardiothoracic intensive care unit patients who received vasopressor agents during 2012.
  
  
  RESULTS
  Norepinephrine and vasopressin were significantly associated with development of pressure ulcers; vasopressin was the only significant predictor in multivariate analysis. In addition, mean arterial pressure less than 60 mm Hg in patients receiving vasopressors, cardiac arrest, and mechanical ventilation longer than 72 hours were predictive of development of pressure ulcers. Patients with a cardiac diagnosis at the time of admission to the intensive care unit were less likely than patients without such a diagnosis to experience pressure ulcers while in the unit.
  
  
  CONCLUSIONS
  The addition of vasopressin administered concomitantly with a first-line agent (often norepinephrine) may represent the point at which the risk for pressure ulcers escalates and may be an early warning to heighten strategies to prevent pressure ulcers. Conversely, because vasopressors cannot be terminated to avert development of pressure ulcers, these findings may add to the body of knowledge on factors that potentially contribute to the development of unavoidable pressure ulcers.
authors.affiliation: Jill Cox is an assistant professor at Rutgers University School of Nursing, Newark, New Jersey, and an advanced practice nurse/certified wound, ostomy, continence nurse at Englewood Hospital and Medical Center, Englewood, New Jersey. Sharon Roche is an advanced practice nurse in critical care at Englewood Hospital and Medical Center. jillcox@sn.rutgers.edu jill.cox@ehmc.com.
authors.forename: Jill
authors.initials: J
authors.lastname: Cox
authors.affiliation: Jill Cox is an assistant professor at Rutgers University School of Nursing, Newark, New Jersey, and an advanced practice nurse/certified wound, ostomy, continence nurse at Englewood Hospital and Medical Center, Englewood, New Jersey. Sharon Roche is an advanced practice nurse in critical care at Englewood Hospital and Medical Center.
authors.forename: Sharon
authors.initials: S
authors.lastname: Roche
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000009:adverse effects; D010656:Phenylephrine / Q000009:adverse effects; D003668:Pressure Ulcer / Q000139:chemically induced*; D012189:Retrospective Studies; D014662:Vasoconstrictor Agents / Q000009:adverse effects*; D014667:Vasopressins / Q000009:adverse effects; D055815:Young Adult
chemical_list: D014662:Vasoconstrictor Agents; D014667:Vasopressins; D010656:Phenylephrine; D009638:Norepinephrine