The relationship between vasopressor administration and pressure ulcer development in adult critical care patients

Purpose: This study examined the relationships between type, dose and duration of five vasopressor agents (Norepinephrine, Vasopressin, Epinephrine, Phenylephrine, Dopamine) and pressure ulcer (PU) development and examined factors that predict PU development in adult critical care patients.

Background/Significance: Vasopressor agents are potent vasoconstricting agents used as a life-saving modality to raise mean arterial pressure in shock states. The pharmacodynamics properties intrinsic to these medications, suggest they may play a role in PU development, however this has been understudied in the literature, making it difficult to discern the agent(s) which may pose the greatest risk.

Method: This study used a retrospective, correlational design. The sample consisted of 306 medical/surgical ICU and cardiovascular adult ICU patients who received vasopressor agents. All data was abstracted from the electronic medical record.  Patients who developed PU were compared to those that remained PU free on all study variables using chi-square and t-tests. Logistic regression analysis was employed to determine the significant predictors of PU development.

Results: Norepinephrine and vasopressin were found to be significantly related to PU development, with vasopressin the only agent to emerge as a significant predictor of PU development in multivariate analysis. Other factors found to be predictive of PU development included cardiac arrest during the ICU admission, longer hours of mean arterial pressure less than 60mmHg on a vasopressor agent, and mechanical ventilation for longer than 72 hours.

Conclusions: The need to add vasopressin, concomitant with a first line vasopressor to the treatment plan may represent a “tipping point” in which PU risk escalates. This may translate for nurses as an early warning to heighten PU prevention strategies. Conversely, as these agents cannot be terminated to avert PU development, this finding may add to the body of knowledge regarding factors that contribute to the development of an unavoidable PU.