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Monitoring Spinal Cord Tissue Oxygen in Patients With Acute, Severe Traumatic Spinal Cord Injuries

Critical Care Medicine (01/06/22) DOI: 10.1097/CCM.0000000000005433

Visagan, Ravindran; Hogg, Florence R.A.; Gallagher, Mathew J.; et al.

https://journals.lww.com/ccmjournal/Abstract/9000/Monitoring_Spinal_Cord_Tissue_Oxygen_in_Patients.95024.aspx

A recent study investigated whether monitoring tissue oxygen tension from the injury site (p_sctO₂) in patients with acute, severe traumatic spinal cord injuries is feasible. The study involved 26 patients with traumatic spinal cord injuries, American spinal injury association Impairment Scale A-C. To monitor intraspinal pressure (ISP), spinal cord perfusion pressure (SCPP), tissue glucose, lactate/pyruvate ratio (LPR), and p_sctO₂, the researchers inserted at the injury site a pressure probe, a microdialysis catheter and an oxygen electrode within 72 hours of injury, for up to a week. Based on 2,213 hours of data, and 6-28 months of follow-up, the researchers found that p_sctO₂ was significantly affected by several factors: ISP, SCPP, tissue glucose, tissue LPR, and fever. However, tissue hypoxia also occurred independently. Raising the FIO2 by 0.48 increased p_sctO₂ by 71.8% over baseline within 8.4 minutes. Changes in p_sctO₂ correlated with changes in limb motor score for patients with motor-incomplete injuries. For those with motor-complete outcomes, the injured cord spent 11% (39%) at p_sctO₂ less than 5 mm Hg, compared with 1% (30%) at p_sctO₂ less than 5 mm Hg for individuals with motor-incomplete outcomes. Five patients experienced cerebrospinal fluid leak, while one had a wound become infected. The findings serve as "the foundation for measuring and altering spinal cord oxygen at the injury site," the authors write, though additional research is needed.

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