Cardiovascular Control After Spinal Cord Injury

Gondim, Francisco de Assis Aquino; Lopes, Adolfo Coelho de Oliveira; Oliveira, G. R. De; Rodrigues, Cleonísio Leite; Leal, Paulo Roberto Lacerda; Santos, Armênio Aguiar dos; Rola, Francisco H.

doi:10.2174/1570161043476474

Cited by 55 publications

(45 citation statements)

References 87 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…9 Accordingly, we propose to use an established meta-analytical method for synthesizing observational studies in order to examine the effect of neurological level of injury on various CV outcomes (BP and HR) at rest in individuals with SCI. Potential confounding factors that are thought to affect CV responses, including age, 10,11 sex, 12 duration of SCI [13][14][15][16] and level of fitness, 17 are also considered to obtain adjusted results. We hypothesize that there will be a lesiondependent impairment in CV function, whereby systolic BP (SBP), diastolic BP (DBP) and HR will be lower in those with the highest (cervical (C)) injuries.…”

Section: Introductionmentioning

confidence: 99%

Influence of the neurological level of spinal cord injury on cardiovascular outcomes in humans: a meta-analysis

2012

View full text Add to dashboard Cite

Background: Although motor and sensory deficits following spinal cord injury (SCI) are well known, there are still contrasting reports on how SCI affects baseline cardiovascular (CV) parameters and other autonomic functions. Study design: Meta-analysis is performed. Objectives: To examine the effect of injury level on supine and seated CV function in individuals with SCI. Methods: A total of 98 studies representing 1968 individuals were retrieved for analysis. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were abstracted from the studies and compared between four groups according to the neurological lesion level, cervical (C) SCI (C4-C8), high-thoracic (HT) SCI (T1-T6), low-thoracic lumbar (LTL) SCI (below T6) and able-bodied (AB) controls. Results: In the supine position, SBP, DBP and HR were lower in C compared with HT, LTL and AB (all Po0.04). In the seated position, SBP and DBP were significantly lower in C compared with LTL and AB (all Po0.003) and HR was significantly lower in C compared with LTL only (P¼0.01). A final finding was that C exhibited a lower resting SBP in the seated compared with the supine position (Po0.001). Conclusion: Individuals with SCI exhibit a lesion-dependent impairment in resting CV function, whereby those with the highest injury had the greatest degree of CV dysfunction. A further finding was that individuals with a C injury exhibited a lower resting SBP in the seated vs supine position. Thus, clinicians and researchers should consider lesion level and body position when measuring and interpreting CV parameters in individuals with SCI.

show abstract

Section: Introductionmentioning

confidence: 99%

Influence of the neurological level of spinal cord injury on cardiovascular outcomes in humans: a meta-analysis

2012

View full text Add to dashboard Cite

show abstract

“…This reaction simulates neurogenic shock and autonomic hyperreflexia in humans. 10,11 Nine studies specifically tested the use of various pharmacologic agents for hemodynamic support in animals with SCIs (Table 1). Mean blood pressure and more specifically, spinal cord blood flow increased significantly using a combination of nimodipine (calcium channel blocker) with epinephrine (vasopressor), dextran (colloid), phenylephrine (vasopressor) and mildly with epinephrine and whole blood.…”

Section: Resultsmentioning

confidence: 99%

A systematic review of the evidence supporting a role for vasopressor support in acute SCI

et al. 2009

View full text Add to dashboard Cite

Study design: A systematic review of clinical and preclinical literature. Objective: To critically evaluate the evidence supporting a role for vasopressor support in the management of acute spinal cord injury and to provide updated recommendations regarding the appropriate clinical application of this therapeutic modality. Background: Only few clinical studies exist examining the role of arterial pressure and vasopressors in the context of spinal cord trauma. Methods: Medical literature was searched from the earlier available date to July 2009 and 32 articles (animal and human literature) answering the following four questions were studied: what patient groups benefit from vasopressor support, which is the optimal hypertensive drug regimen, which is the optimal duration of the treatment and which is the optimal arterial blood pressure. Outcome measures used were the incidence of patients needing vasopressors, the increase of arterial blood pressure and neurologic improvement. Results: Patients with complete cervical cord injuries required vasopressors more frequently than either incomplete injuries or thoracic/lumbar cord injuries (Po0.001). There was no statististical difference in neurologic improvement between patients on vasopressor support with a mean arterial pressure (MAP) of less than 85 mm Hg and those with MAP less than 90 mm Hg. Duration of treatment is often recommended between 5 and 7 days although this is not supported by high-level evidence and no single vasopressor appeared superior over the variety used in clinical treatment. Conclusion: There is currently no gold standard on vasopressor support. Based on non-randomized human studies, complete cervical cord injuries require vasopressors more frequently than other spinal cord injuries.

show abstract

“…It is caused by a deafferented spinal cord stimulated by a stimulus triggered mostly by the distention of visceral organs in the pelvic region in injuries over the T5-6 sympathetic splanchnic exit level of the spinal cord. 12 Although AD is described as a symptom complex that develops as a response to a noxious stimulant below the lesion level and is characterized by bradycardia and sudden increase in BP, 13 how much the increase in BP should be and whether a DBP increase is required together with SBP and whether HR changes should accompany the BP increase in order to identify BP elevation as AD are controversial. Some authors describe the SBP increasing more than 20-30 mmHg or 20-30% as a dysreflexic episode [14][15][16][17] while other authors have reported that a decrease of 15% in the HR together with a 30% increase in SBP and DBP may indicate AD, 16 that a BP exceeding 160/90 mmHg 18 or 150/100 mmHg may be a finding of AD, 19 and that a sudden increase in SBP and DBP of 20-40 mmHg and accompanying bradycardia may be a finding of AD.…”

Section: Discussionmentioning

confidence: 99%

Monitoring development of autonomic dysreflexia during urodynamic investigation in patients with spinal cord injury

Koyuncu

Ersöz

2016

The Journal of Spinal Cord Medicine

View full text Add to dashboard Cite

Objectives: We aimed to investigate whether autonomic dysreflexia (AD) develops during urodynamic investigation in patients with spinal cord injury (SCI) with neurological level below thoracic (T) 6 together with the frequency and related factors for AD development. Study Design: Prospective study. Methods: The systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) of 51 SCI patients with a neurological level below T6 were measured and recorded at the beginning and every two minutes during the filling phase of the urodynamic study. The changes between the SBP, DBP and HR values at the beginning and end of the filling phase were analyzed. Results: Autonomic dysreflexia developed only in one of the 51 patients included into the study. The BP of this patient increased from 105/76 mmHg to 145/102 mmHg and the HR dropped from 88 beats/minute (bpm) to 69 bpm together with development of the AD symptoms. The patient was a 47-year-old male with a neurological level at T8. A significant difference was found between the mean SBP and the mean DBP values at the beginning and end of the filling phase. Conclusions: Although rare, AD can be seen during urodynamic investigation in patients with a neurological level below T6, especially when close to the T6 level. Therefore, we suggest that the patients with a neurological level below T6 and especially closer to T6 level should be followed-up in terms of development of AD. The clinicians should take into account the HR values in addition to the the SBP and DBP values at follow-ups.

show abstract

Cardiovascular Control After Spinal Cord Injury

Cited by 55 publications

References 87 publications

Influence of the neurological level of spinal cord injury on cardiovascular outcomes in humans: a meta-analysis

Influence of the neurological level of spinal cord injury on cardiovascular outcomes in humans: a meta-analysis

A systematic review of the evidence supporting a role for vasopressor support in acute SCI

Monitoring development of autonomic dysreflexia during urodynamic investigation in patients with spinal cord injury

Contact Info

Product

Resources

About