Monitoring spinal cord hemodynamics and tissue oxygenation: a review of the literature with special focus on the near-infrared spectroscopy technique

Rashnavadi, Tahereh; Macnab, Andrew; Cheung, Amanda; Shadgan, Armita; Shadgan, Babak

doi:10.1038/s41393-019-0304-2

Cited by 24 publications

(22 citation statements)

References 68 publications

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“…Such a probe will provide several ISP, sPRx, and SCPP readings simultaneously, which would require the concept of SCPP opt to be redefined. An alternative to inserting probes intradurally is noninvasive, transcutaneous monitoring of hemoglobin oxygenation by near-infrared spectroscopy [40], although beam scatter by skin, muscle, bone, and metalwork may hinder such techniques. The recent availability of online MD, which allows continuous monitoring of extracellular tissue glucose, lactate, and pyruvate, may reveal novel pathological phenomena that occur at the timescale of seconds rather than hours.…”

Section: Future Directionsmentioning

confidence: 99%

Targeted Perfusion Therapy in Spinal Cord Trauma

Saadoun

Papadopoulos

2020

Neurotherapeutics

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We review state-of-the-art monitoring techniques for acute, severe traumatic spinal cord injury (TSCI) to facilitate targeted perfusion of the injured cord rather than applying universal mean arterial pressure targets. Key concepts are discussed such as intraspinal pressure and spinal cord perfusion pressure (SCPP) at the injury site, respectively, analogous to intracranial pressure and cerebral perfusion pressure for traumatic brain injury. The concept of spinal cord autoregulation is introduced and quantified using spinal pressure reactivity index (sPRx), which is analogous to pressure reactivity index for traumatic brain injury. The Ushaped relationship between sPRx and SCPP defines the optimum SCPP as the SCPP that minimizes sPRx (i.e., maximizes autoregulation), and suggests that not only ischemia but also hyperemia at the injury site may be detrimental. The observation that optimum SCPP varies between patients and temporally in each patient supports individualized management. We discuss multimodality monitoring, which revealed strong correlations between SCPP and injury site metabolism (tissue glucose, lactate, pyruvate, glutamate, glycerol), monitored by surface microdialysis. Evidence is presented that the dura is a major, but unappreciated, cause of spinal cord compression after TSCI; we thus propose expansion duroplasty as a novel treatment. Monitoring spinal cord blood flow at the injury site has revealed novel phenomena, e.g., 3 distinct blood flow patterns, local steal, and diastolic ischemia. We conclude that monitoring from the injured spinal cord in the intensive care unit is a safe technique that appears to enable optimized and individualized spinal cord perfusion.

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Section: Future Directionsmentioning

confidence: 99%

Targeted Perfusion Therapy in Spinal Cord Trauma

Saadoun

Papadopoulos

2020

Neurotherapeutics

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“…The other two NIRS probes were placed on the thoracic (fourth to sixth) and lumbar (first to third, Fig. 1b) laminae of the vertebral arch, which were surgically exposed and flattened after removing the spinous process, to exclude paraspinal blood flow [29]. Because we used the probe with a distance of 30 mm between the emitter and receiver ( Fig.…”

Section: Animal Preparationmentioning

confidence: 99%

Spinal cord autoregulation using near-infrared spectroscopy under normal, hypovolemic, and post-fluid resuscitation conditions in a swine model: a comparison with cerebral autoregulation

et al. 2020

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Background: Few studies have investigated spinal cord autoregulation using near-infrared spectroscopy (NIRS). Here, we assessed spinal cord autoregulation under normal, hypovolemic, and post-fluid resuscitation conditions compared with cerebral autoregulation. Methods: Ten pigs (36.1 ± 1.1 kg) were anesthetized with 2.5% isoflurane, before phenylephrine administration at 0.5, 1, 2, and 5 μg kg −1 min −1 in a stepwise fashion at 10-min intervals (baseline), followed by similar administration of sodium nitroprusside (SNP). Hypovolemia was induced by a 600-ml bleed (25% estimated total blood volume). Only phenylephrine was readministered (same protocol). Hypovolemia was reversed by infusing 600 ml hydroxyethyl starch, before readministering phenylephrine and SNP. The relationships between mean arterial pressure (MAP) and cerebral, thoracic, and lumbar spinal cord tissue oxygenation indices (TOIs) were evaluated. Results: Thoracic and lumbar spinal cord TOIs were approximately 15% and 10% lower, respectively, than the cerebral TOI at similar MAPs. The average relationship between MAP and each TOI showed an autoregulatory pattern, but negative correlations were observed in the cerebral TOI during phenylephrine infusion. A 600-ml bleed lowered each relationship < 5% and subsequent fluid resuscitation did not change the relationship. Individual oxygenation responses to blood pressure indicated that the spinal cord is more pressure-passive than the cerebrum. Paradoxical responses (an inverse relationship of tissue oxygenation to MAP) were observed particularly in cerebrum during phenylephrine infusion and were rare in the spinal cord.Conclusions: Spinal cord autoregulation is less robust than cerebral autoregulation and more pressure-dependent. Similar to cerebral oxygenation, spinal cord oxygenation is volume-tolerant but is more sensitive to hypotension.

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“…However, in certain people, raising MAP through the use of highdose vasopressors might lead to drug-related problems. In fact, managing an acute SCI patient's hemodynamics within the first week after damage is crucial and difficult [39].…”

Section: Managementmentioning

confidence: 99%

Spinal Cord Injuries in Emergency Medicine

Sonbul

Aljohani

Alqefari

et al. 2021

JPRI

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Spinal cord injury is a serious medical disorder that frequently leads in significant morbidity and permanent impairment. Direct damage to the spinal cord or compression owing to broken vertebrae or masses such as epidural hematomas or abscesses are the most common causes of spinal cord injury. When examining a blunt trauma victim, medical professionals are taught to presume the patient has a spinal column damage unless it is proven otherwise. The early examination of a patient with a suspected cervical spinal injury in the emergency department (ED) is no different than that of any other trauma patient. The ABCs, or airway, breathing, and circulation, procedures are being taken into consideration. In acute spinal cord damage, hypotension can be hemorrhagic or neurogenic. Because of the high prevalence of concomitant injuries and vital sign confusion in acute spinal cord injury, a thorough search for hidden sources of bleeding is required. Surgical removal of bone fragments, foreign objects, herniated discs, or broken vertebrae that appear to be compressing the spine is frequently required. In order to avoid future discomfort or deformity, surgery may be required to stabilize the spine. In this review we’ll be looking at spinal cord injury, it’s diagnosis and treatment.

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Monitoring spinal cord hemodynamics and tissue oxygenation: a review of the literature with special focus on the near-infrared spectroscopy technique

Cited by 24 publications

References 68 publications

Targeted Perfusion Therapy in Spinal Cord Trauma

Targeted Perfusion Therapy in Spinal Cord Trauma

Spinal cord autoregulation using near-infrared spectroscopy under normal, hypovolemic, and post-fluid resuscitation conditions in a swine model: a comparison with cerebral autoregulation

Spinal Cord Injuries in Emergency Medicine

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