Author: Nick Hatch, MD.

Educational Pearls:

• A common concern using vasopressors is the risk of digital and mesenteric ischemia.

• The absolute risk of digital ischemia and/or mesenteric ischemia is pretty low. Norepinephrine at its highest doses carries a 5% digital ischemia rate and a 2% mesenteric ischemia rate.

• The studies demonstrating this complication were predominately patients with pre-existing liver disease.

• Providers commonly mistake purpura fulminans, a common complication of sepsis, for digital ischemia.

References

Brown, SM. et al. Survival After Shock Requiring High-Dose Vasopressor Therapy. Chest. 2013. 143(3), 664–671. http://doi.org/10.1378/chest.12-1106.

Malay MB et al. Heterogeneity of the vasoconstrictor effect of vasopressin in septic shock. Critical Care Medicine. 2004. 32(6), 1327-31.