Assessment of Microcirculatory Changes in Patients With Cervical Spinal Cord Injuries and Neurogenic Shock During the Acute Phase Using Near-Infrared Spectroscopy

Background Cervical spinal cord injury (SCI) is a severe condition that can lead to neurogenic shock, a life-threatening complication. Neurogenic shock is characterized by a sudden impairment of sympathetic tone, resulting in vasodilation, hypotension, and bradycardia. This disruption can significantly affect blood flow dynamics, particularly in the microcirculation. Near-infrared spectroscopy (NIRS) is a device that enables the monitoring of tissue oxygenation and the assessment of microcirculatory status. This study aimed to apply NIRS in conjunction with the vascular occlusion test (VOT) to evaluate microcirculatory function in SCI patients with neurogenic shock and analyze its association with in-hospital mortality. Methods This prospective study included cervical SCI patients with neurogenic shock on whom NIRS was performed along with VOT within 24 hours after admission in the ICU (T0). Follow-up measurements were taken at the time of the acute phase (D0), and on days 3, 5, and 7. The de-oxygenation (DeO2) slope, re-oxygenation (ReO2) slope, and the reperfusion area were recorded. The prevalence of microcirculatory dysfunction, and mortality rate were primary outcomes of this study. Results The prevalence of microcirculatory alterations was 239 (92%), with 122 (47%) of patients still exhibiting alterations at day 7 (D7). Survivors had higher NIRS parameters at D0 compared to non-survivors. The ReO2 slope at D0 was significantly decreased in patients who developed new-onset kidney injury and nosocomial infections. Conclusion The prevalence of microcirculatory disturbance was high in patients with an SCI and neurogenic shock, and it was linked to in-hospital mortality and complications.