Septic shock

Vasopressors used in critically ill patients with refractory shock pose a serious risk of non-occlusive peripheral limb ischemia leading to tissue necrosis ...

(December 30, 2022) Management of Vasopressor-Induced Acute Limb Ischemia (VIALI) in Septic Shock . Similar cyanosis and ischemic changes were noted in the toes bilaterally (Figure [2](#figure-anchor-493910)). Following the emptying of the veins, the pressure gradient between the arterial and venous system is increased which promotes the arterial blood flow down to the toes and ischemic tissues. In a retrospective study that included 98 ICU patients, 80 patients were exposed to vasoactive drugs, with phenylephrine (55%), norepinephrine (47%), ephedrine (31%), epinephrine (26%), and vasopressin (24%) being the most prevalent [[7]](#references). [[5]](#references). Arterial Assist Device® (Art Assist Pump) was applied to both upper and lower extremities. She was continued on vasopressor support to target mean arterial pressure (MAP) of greater than 65 (mm Hg). She was noted to be hypotensive with a BP of 90/48 (mm Hg) and a heart rate of 120 (bpm). A 56-year-old woman presented to an outside emergency room with a fever of 102 F, vomiting, right lower abdominal pain, a heart rate of 142 beats per minute, and blood pressure of 102/66 (mm Hg). Urinary tract is the source of 9% to 31% of sepsis cases [[3,4]](#references). [[1,2]](#references). There is a scarcity of evidence-based medical literature on the prevention and management of vasopressor induced acute limb ischemia (VIALI).