Palliative Use of Nitroglycerin to Improve Microvascular Circulation

Area of Science:

• Critical care medicine
• Pharmacology

Background:

• Vasopressor use in critical illness can lead to peripheral ischemia, causing physical changes like mottling and cooling of extremities.
• These changes can impede meaningful physical interactions between patients and their families during end-of-life care.
• When comfort measures are chosen, clinicians must manage existing distal malperfusion while respecting patient and family wishes.

Observation:

• A case series explored the use of intravenous nitroglycerin to address postvasopressor digital ischemia.
• The intervention was specifically applied in the context of comfort care measures.

Findings:

• Intravenous nitroglycerin successfully improved digital ischemia in patients experiencing peripheral malperfusion due to vasopressor therapy.
• This intervention allowed for improved physical interactions between patients and families.

Implications:

• Management during comfort care extends beyond pain control to include dignified dying.
• Reversing digital ischemia with nitroglycerin can facilitate meaningful touch and support the grieving process for families.
• This approach highlights the importance of addressing physical symptoms to enhance the end-of-life experience for both patients and their loved ones.