To date, studies addressing the pharmacological management of neurogenic shock in acute SCI are limited and only one study has been published which investigated the effect of pseudoephedrine as an adjuvant therapy in acute SCI patients.
In terms of the pharmacological management of neurogenic shock during acute SCI, one case series conducted by Wood et al. (2014) investigated the effectiveness of pseudoephedrine as an adjunctive therapy option to the use of vasopressors and atropine. Patients who were administered pseudoephedrine for more than one day during their hospital stay or who received vasopressor support and/or atropine were retrospectively reviewed. Treatment with pseudoephedrine was considered successful based on discontinued vasopressor and atropine use, or a reduction in bradycardic episodes following pseudoephedrine administration; effectiveness was observed in 82% of patients. However, the effects of treatment were not immediate as the mean duration of pseudoephedrine therapy lasted 32 days on average.
There is level 4 evidence (from one case series study; Wood et al. 2014) that pseudoephedrine may be an effective adjuvant for the treatment of neurogenic shock in acute SCI patients; however, this pharmacological agent may require up to one month for effectiveness.
Pseudoephedrine may be an effective adjuvant for the treatment of neurogenic shock during the acute phase post SCI; however, pseudoephedrine may require up to one month for effectiveness.