Effect of infused norepinephrine dosage on pressure ulcers in perianesthesia care unit patients: a pilot study

To determine whether treatment with moderate-high dose norepinephrine is a contributory cause increasing the risk of pressure ulcer development in critical postoperative, mechanically ventilated, hyperglycemic patients. A pilot clinical cohort study was conducted in a PACU in a tertiary hospital. A convenience sample of 16 hyperglycemic patients undergoing mechanical ventilation with at least 24 hours' stay in the PACU were divided into two groups of eight according to dosage of norepinephrine infusion at any moment during the days monitored. One group received ≥ 2.5 mg/hour, and the other received <2.5 mg/hour. The dose of norepinephrine administered by continuous venous infusion and the occurrence of stage II pressure ulcers were recorded. The proportion of patients with pressure ulcers in the group receiving moderate-high dose of norepinephrine was 50% compared with 0% in the low-dose group (P = .038). The odds ratio for daily average norepinephrine administered (mg/hour) was 2.21 (95% CI = 1.27 to +infinite); exact P = .0049. The odds ratio for daily average norepinephrine administered adjusting for weight (mg/kg/hour) was 3.05 (95% CI = 1.299 to +infinite); exact P = .0016. Moderate-high dose norepinephrine is a contributory cause that significantly increases the risk of pressure ulcer development in certain short-stay PACU patients.