Limb Necrosis in the Setting of Vasopressor Use

Authors

Kendall H. Derry, Kendall H. Derry is a resident physician, Department of Orthopedic Surgery, NYU Langone Health, New York, New York.
Madeline C. Rocks, Madeline C. Rocks is a medical student, George Washington University School of Medicine and Health Sciences, Washington, DC.
Paul Izard, Paul Izard is a medical student, Harvard Medical School, Boston, Massachusetts.
Rebecca S. Nicholas, Rebecca S. Nicholas is an attending physician, Division of Hand Surgery, Department of Orthopedic Surgery, NYU Langone Health, New York, New York.
Philip M. Sommer, Philip M. Sommer is an attending physician, Perioperative Care and Pain Medicine Division, Department of Anesthesiology, NYU Langone Health, New York, New York.
Jacques H. Hacquebord, Jacques H. Hacquebord is an attending physician and chief, Division of Hand Surgery, Department of Orthopedic Surgery, Hansjorg Wyss Department of Plastic Surgery, NYU Langone Health, New York, New York.

Document Type

Journal Article

Publication Date

5-1-2024

Journal

American journal of critical care : an official publication, American Association of Critical-Care Nurses

Volume

33

Issue

3

DOI

10.4037/ajcc2024171

Abstract

BACKGROUND: It remains poorly understood why only some hemodynamically unstable patients who receive aggressive treatment with vasopressor medications develop limb necrosis. OBJECTIVE: To determine the incidence of limb necrosis and the factors associated with it following high-dose vasopressor therapy. METHODS: A retrospective case-control medical records review was performed of patients aged 18 to 89 years who received vasopressor therapy between 2012 and 2021 in a single academic medical center. The study population was stratified by the development of limb necrosis following vasopressor use. Patients who experienced necrosis were compared with age- and sex-matched controls who did not experience necrosis. Demographic information, comorbidities, and medication details were recorded. RESULTS: The incidence of limb necrosis following vasopressor administration was 0.25%. Neither baseline demographics nor medical comorbidities differed significantly between groups. Necrosis was present in the same limb as the arterial catheter most often for femoral catheters. The vasopressor dose administered was significantly higher in the necrosis group than in the control group for ephedrine (P = .02) but not for the other agents. The duration of therapy was significantly longer in the necrosis group than in the control group for norepinephrine (P = .001), epinephrine (P = .04), and ephedrine (P = .01). The duration of vasopressin administration did not differ significantly between groups. CONCLUSION: The findings of this study suggest that medication-specific factors, rather than patient and disease characteristics, should guide clinical management of necrosis in the setting of vasopressor administration.

APA Citation

Derry, Kendall H.; Rocks, Madeline C.; Izard, Paul; Nicholas, Rebecca S.; Sommer, Philip M.; and Hacquebord, Jacques H., "Limb Necrosis in the Setting of Vasopressor Use" (2024). GW Authored Works. Paper 4997.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/4997

Department

School of Medicine and Health Sciences Student Works