How is neurogenic shock managed in the treatment of spinal cord injury (SCI)?

Updated: Nov 01, 2018
  • Author: Lawrence S Chin, MD, FACS; Chief Editor: Brian H Kopell, MD  more...
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Answer

Once occult sources of hemorrhage have been excluded, initial treatment of neurogenic shock focuses on fluid resuscitation. Judicious fluid replacement with isotonic crystalloid solution to a maximum of 2 L is the initial treatment of choice. Overzealous crystalloid administration may cause pulmonary edema, because these patients are at risk for the acute respiratory distress syndrome (ARDS).

The therapeutic goal for neurogenic shock is adequate perfusion with the following parameters:

  • A systolic blood pressure (BP) of 90-100 mm Hg should be achieved; systolic BPs in this range are typical for patients with complete cord lesions. Compelling animal and human studies recommend maintenance of systolic BP above 90 mm Hg and to avoid any hypotensive episodes [4, 5]

  • The most important treatment consideration is to maintain adequate oxygenation and perfusion of the injured spinal cord; supplemental oxygenation and/or mechanical ventilation may be required [4, 5]

  • Heart rate should be 60-100 beats per minute (bpm) in normal sinus rhythm

  • Hemodynamically significant bradycardia may be treated with atropine

  • Urine output should be more than 30 mL/h; placement of a Foley catheter to monitor urine output and to decompress the neurogenic bladder is essential

  • Rarely, inotropic support with dopamine or norepinephrine is required; this should be reserved for patients who have decreased urinary output despite adequate fluid resuscitation; usually, low doses of dopamine in the 2- to 5-mcg/kg/min range are sufficient

  • Prevent hypothermia


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