Evaluation of Vasopressor Dose and the Incidence of Pressure Injuries in Critically Ill Patients.

OBJECTIVE: To evaluate risk factors associated with vasopressor use and development of hospital-acquired pressure injuries (HAPIs). METHODS: The researchers conducted a retrospective chart review in a 12-bed medical ICU at a community hospital. A total of 123 patients who received a minimum of 24 hours of continuous vasopressor administration between January 2017 and January 2019 were included. The primary outcomes assessed were vasopressor dose and HAPI incidence, with a subgroup analysis based on type. Secondary outcomes included quantity of vasopressors, duration, mean arterial pressure, mechanical ventilation, time to injury, severity, and location. RESULTS: The overall incidence of HAPIs was 20.3%, with 17% incidence in the low-dose cohort and 22.4% in the high-dose cohort ( P = .317). There were no differences in the subgroup analysis based on vasopressor type. The most common locations for injuries were the sacrum and coccyx, with the majority being stage 1 or 2 based on the National Pressure Injury Advisory Panel severity staging. No correlations were found between HAPI incidence and factors such as multiple vasopressors use, mechanical ventilation, mean arterial pressure, or duration of vasopressor administration. The documentation of time to injury was significantly shorter in the high-dose cohort compared with the low-dose cohort (157.58 vs 330.86 hours, P < .05). CONCLUSIONS: The incidence of HAPIs did not differ between the low- and high-dose vasopressor cohorts. However, patients who received higher doses of vasopressors had documented pressure injuries sooner than the low-dose cohort, emphasizing the importance of close monitoring for HAPIs in patients receiving vasopressors.

Mental health functioning and severity of cannabis withdrawal among medical cannabis users with chronic pain.

PURPOSE: To describe patterns of cannabis withdrawal among a large sample of those who use medical cannabis and test the association between withdrawal symptomology and functioning. PROCEDURES: Adults ages 21 and older (N = 801) who were seeking medical cannabis certification (either for the first time or as a renewal) for chronic pain at medical cannabis clinics in southern Michigan completed baseline measures of cannabis use, withdrawal symptomology, functioning and other related constructs. Patients were included in the current study if they endorsed using cannabis at least weekly over the past three months. Of the persons in the baseline sample (N = 801), 83% endorsed using cannabis at this level of frequency and duration (N = 665). FINDINGS: Approximately two-thirds of the sample (67.8%) reported at least one moderate or severe withdrawal symptom. The most commonly observed symptom was sleep difficulties (50.3%), followed by anxiety (27.8%), irritability (26.7%), and appetite disturbance (25.2%). Patients with low mental functioning had significantly higher rates of withdrawal symptom endorsement than patients with high mental functioning. However, no association was observed between physical functioning and withdrawal symptom endorsement. These patterns of association were consistent in multivariate analyses that controlled for other potentially confounding variables. CONCLUSIONS: Cannabis withdrawal symptomology is highly prevalent among patients who use medical cannabis at least three times a week. Helping patients recognize the association between poorer functioning and withdrawal may be an effective way to highlight potentially negative consequences of regular and moderate heavy use.