Article
Sacral transcutaneous oxygen tension levels in the spinal cord injured: Risk factors for pressure ulcers?

https://doi.org/10.1016/0003-9993(93)90037-BGet rights and content

Abstract

Evidence is mounting that susceptibility to pressure ulcers in the spinal cord injured is due to the interactive effects of prolonged immobilization and injury-related autonomic dysfunction associated with reduced tissue perfusion. To determine whether tissue oxygenation at the sacrum is reduced in spinal cord injury, we compared transcutaneous oxygen tension (PtcO2) levels in 21 subjects with spinal cord injury and 11 able-bodied controls lying prone and supine on egg-crate mattresses. Spinal cord injured subjects above and below the median supine PtcO2 value were also compared in terms of the presence or absence of pressure ulcers. The PtcO2 level of the spinal cord injured (mean ± SD) was lower than that of the controls in the prone position (65.3 ± 16mmHg vs 76.4 ± 13mmHg; F = 3.9, df = 1, p = .053), and markedly lower in the supine position (49.1 ± 26mmHg versus 74.2 ± 10mmHg; F = 9.7, df = 1, p = .004). Examination of mean PtcO2 levels over time showed that those of the controls fell slightly following supination but returned to the previous level within 15 minutes. In contrast, those of the spinal cord injured fell rapidly by 18mmHg and stabilized after 15 minutes at a level 27mmHg below that of the controls. Five of the 10 (50%) spinal cord injured subjects with PtcO2 levels below the median supine PtcO2 level had a pressure ulcer compared to one among the 11 (9%) spinal cord injured subjects with PtcO2 levels above the median (p = .055, by Fisher's exact test). These results suggest the need for further studies on the role of reduced tissue oxygenation in the etiology of pressure ulcers.

References (34)

  • KW Perdue et al.

    Decubitus ulcers

    J Am Board Fam Pract

    (1989)
  • RK Daniel et al.

    Etiologic factors in presure sores: experimental model

    Arch Phys Med Rehabil

    (1983)
  • L Guttmann

    Spinal cord injuries: comprehensive management and research

    (1976)
  • GP Rodriguez et al.

    Adrenergic receptors in insensitive skin of spinal cord injured patients

    Arch Phys Med Rehabil

    (1986)
  • MJ Rosner et al.

    New principles of resuscitation for brain and spinal injury

    N Carolina Med J

    (1984)
  • A Munro et al.

    Catecholaminergic content of peripheral plasma in human subjects with complete transverse lesions of the spinal cord

    J Physiol

    (1960)
  • CJ Mathias et al.

    Plasma catecholamines during paroxysmal neurogenic hypertension in quadriplegic man

    Circ Res

    (1976)
  • Cited by (32)

    • Changes in sympathetic neurovascular function following spinal cord injury

      2018, Autonomic Neuroscience: Basic and Clinical
      Citation Excerpt :

      Therefore another possible explanation for impairment of sensory nerve mediated-vasodilation is spinal reflex activation of sympathetic-vasoconstrictor axons in SCI subjects (Kuesgen et al., 2002). The transcutaneous oxygen tension levels measured in sacral skin (covering the base of the spine where pressure sores commonly develop) have been reported to be lower in subjects with SCI, indicating poor nutritive blood flow in the superficial layers of the skin (Mawson et al., 1993). Furthermore, as SCI lowers BP, blood flow in skin can be occluded with lower externally applied pressures than in able-bodied subjects (Schubert and Fagrell, 1991).

    • A repeat audit of spinal board usage in the emergency department

      2008, Injury
      Citation Excerpt :

      One study identified that the incidence of pressure sores over the bony prominences can be related back to prolonged time spent on the spinal board whilst waiting for investigations.6 Shocked patients have a reduced perfusion pressure and those with spinal injuries with potential neurological deficit in auto-regulation of blood pressure and loss of pain sense are at greater risk of sores.7,8 Ironically, it is these patients that are likely to be placed on boards in the first instance and are likely to stay on them longer due to complicated management plans.

    • Cardiovascular consequences of loss of supraspinal control of the sympathetic nervous system after spinal cord injury

      2000, Archives of Physical Medicine and Rehabilitation
      Citation Excerpt :

      Similar arteriovenous shunting has been reported in individuals with quadriplegia.139 Transcutaneous oxygen tension is reportedly significantly lower in individuals with SCI than in controls, especially in the supine position.140 As mentioned previously, individuals with high cord injuries suffer reduced resting blood pressure.

    View all citing articles on Scopus
    View full text