Characterization of the spectrum of hemodynamic profiles in trauma patients with acute neurogenic shock

Abstract

Objective Neurogenic shock considered a distributive type of shock secondary to loss of sympathetic outflow to the peripheral vasculature. In this study, we examine the hemodynamic profiles of a series of trauma patients with a diagnosis of neurogenic shock. Methods Hemodynamic data were collected on a series of trauma patients determined to have spinal cord injuries with neurogenic shock. A well-established integrated computer model of human physiology was used to analyze and categorize the hemodynamic profiles from a system analysis perspective. A differentiation between these categories was presented as the percent of total patients. Results Of the 9 patients with traumatic neurogenic shock, the etiology of shock was decrease in peripheral vascular resistance (PVR) in 3 (33%; 95% confidence interval, 12%–65%), loss of vascular capacitance in 2 (22%; 6%–55%) and mixed peripheral resistance and capacitance responsible in 3 (33%; 12%–65%), and purely cardiac in 1 (11%; 3%–48%). The markers of sympathetic outflow had no correlation to any of the elements in the patients' hemodynamic profiles. Conclusions Results from this study suggest that hypotension of neurogenic shock can have multiple mechanistic etiologies and represents a spectrum of hemodynamic profiles. This understanding is important for the treatment decisions in managing these patients.

Theoretical Analysis of the Relative Impact of Obesity on Hemodynamic Stability During Acute Hemorrhagic Shock

“…The mathematical package used in the current analysis was a homegrown product developed by one of the authors (Coleman) using C++ as the programming language. This model and methodology, which previously have been used in numerous studies, are intended to provide a more detailed understanding of the physiologic mechanisms involved in common clinical conditions ( 11 , 13 - 15 , 19 , 20 ). Further, several versions of this model have been previously demonstrated to accurately predict hemodynamic changes seen during hypotensive states ( 11 , 17 , 20 ).…”

“…This model and methodology, which previously have been used in numerous studies, are intended to provide a more detailed understanding of the physiologic mechanisms involved in common clinical conditions ( 11 , 13 - 15 , 19 , 20 ). Further, several versions of this model have been previously demonstrated to accurately predict hemodynamic changes seen during hypotensive states ( 11 , 17 , 20 ). The model has been specifically validated previously for hemorrhagic states in a published study in which humans were placed in a simulated shock state by a standard lower body negative pressure technique ( 17 ).…”

Complications and outcomes of vasopressor usage in acute traumatic central cord syndrome

“…Given the propensity for cardiovascular complications following SCI, including hypotensive neurogenic shock and autonomic dysreflexia-induced hypertension, optimizing vasopressor support is a critically important issue. 20,27 Considering the high prevalence of ATCCS in elderly patients and our findings of increased risk of dopamine-related complications in elderly patients with ATCCS, further research is needed to determine the optimal MAP guidelines for ATCCS.…”

Neurogenic Shock: Clinical Management and Particularities in an Emergency Room

“…As dores anais após o retorno da contração do esfíncter anal refletem o desequilíbrio entre o controle autônomo simpático e parassimpático após a lesão medular. 15,18,22 Abordagem Inicial ao Paciente na Sala de Emergência O suporte hemodinâmico precoce é o objetivo terapêutico para que não haja lesões de órgãos nobres. As diretrizes do Advanced Trauma Life Support (ATLS TM ) preconizam a garantia de uma via aérea segura com anterior estabilização da coluna cervical; portanto, mantendo o colar cervical durante toda a avaliação e manejo do paciente.…”