Septic Shock Complicated with Limb Ischemic Necrosis: Three Case Reports and their Review of Literature

Purpose: Limb ischemic necrosis is a very rare but severe condition that generally leads to amputation in septic shock. Our aim is to review the risk factors for development of limb ischemic necrosis in ICU patients requiring vasopressor support and draw the attention of doctors. Methods: A retrospective review of clinical information and photographs in 3 septic shock patients, including APACHII scores, dose of norepinephrine, time of ischemic necrosis and final outcome from July 2001 to June 2020 at a single intensive care unit. Results: All of the three patients had high APACHE II score, obvious coagulation dysfunction and severe hypotension on admission; In order to maintain the target blood pressure, the dose of norepinephrine range from 0.36 to 7.27 μg/kg/min; Case 2 and 3 had a higher average dose and length of NE treatment when comparing to case 1. Finally, case 1 survived but undergone amputation, case 2 and case 3 died. Conclusion: Septic shock with limb ischemic necrosis is a very serious complication and may indicate a poor prognosis. As an ICU doctor, we should pay attention to the complication in our clinical practice which can greatly affect patient’s quality of later life.