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Effectiveness of Pseudoephedrine as Adjunctive Therapy for Neurogenic Shock After Acute Spinal Cord Injury: A Case Series
Author(s) -
Wood G. Christopher,
Boucher Andrew B.,
Johnson Jessica L.,
Wisniewski Jennifer N.,
Magnotti Louis J.,
Croce Martin A.,
Swanson Joseph M.,
Boucher Bradley A.,
Fabian Timothy C.
Publication year - 2014
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1002/phar.1335
Subject(s) - medicine , pseudoephedrine , discontinuation , anesthesia , bradycardia , adjunctive treatment , spinal cord injury , shock (circulatory) , blood pressure , surgery , heart rate , ephedrine , spinal cord , psychiatry
Study Objective To evaluate the effectiveness of pseudoephedrine as adjunctive therapy for neurogenic shock in patients with acute spinal cord injury ( SCI ). Design Case series. Setting Academic medical center. Patients Thirty‐eight patients admitted to the trauma intensive care unit between September 2005 and October 2012 with an acute SCI and who received more than 1 day of pseudoephedrine for one or more of the following: treatment of bradycardia (heart rate < 50 beats/min), treatment of hypotension (systolic blood pressure < 90 mm Hg), or were receiving intravenous vasopressor support. Measurements and Main Results The effect of adjunctive pseudoephedrine (PSE) was categorized as a success if vasopressors were discontinued after the initiation of PSE or improvement in the number of episodes of bradycardia was noted after the initiation of PSE as evidenced by decreased use of atropine. The effect of pseudoephedrine was categorized as a failure if it did not meet one of the criteria for success. The effect of pseudoephedrine was categorized as inconclusive if there were confounding factors such as vasopressors being restarted for another indication after initial discontinuation. Pseudoephedrine was successful in 31/38 (82%) patients, failed in 2/38 (5%) patients, and had inconclusive results in 5/38 (13%) patients. The mean ± SD time to successful weaning of intravenous vasopressors was 7 ± 7 days. Daily maximum pseudoephedrine doses ranged from 60–720 mg. Mean ± SD duration of pseudoephedrine therapy was 32 ± 23 days (range 2–135 days), with 64.5% of surviving patients discharged while receiving pseudoephedrine. Conclusion These data suggest that pseudoephedrine is an effective adjunctive therapy in facilitating the discontinuation of intravenous vasopressors and/or atropine in patients with acute SCI with neurogenic shock, although patients will typically require long durations of therapy.