We have not done any further analysis; therefore, we still do not know the exact etiological factor (vasopressor vs shock sequelae vs overall severity of illness) that places the patient at increased risk for PI. We strongly suspect that vasopressors and especially vasopressin play a significant role in PI development. Although we know that cutaneous manifestations associated with vasopressor medications exist, the evidence is not strong as to whether the associated gangrene is related to vasopressors or to the sequelae of shock that the vasopressors were administered to treat.

When patients are receiving vasopressors, PI interventions such as more frequent repositioning or small repositioning shifts may be indicated, depending on the support surface in use and the patient’s individual tissue tolerance. For example, in patients with anasarca, tissue tolerance is severely compromised and increased frequency of repositioning/off-loading may be necessary. The use of prophylactic multilayer silicone foam dressings, if they...

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