Critical Care of Traumatic Cervical Spinal Cord Injuries: Preventing Secondary Injury

Abstract

The incidence of traumatic spinal cord injury (SCI) has not changed much over the years due to an aging population suffering falls, yet advances have been made in quality of life and survival time. In addition to initial medical and surgical stabilization, modern intensive care unit (ICU) care throughout the critical early period following SCI is essential to avoid continued secondary injury to the spinal cord. Cervical SCI patients are particularly prone and sensitive to periods of cardiovascular instability and respiratory failure directly resulting from their injuries. Preclinical and class III clinical data suggest improved outcomes by maintaining the mean arterial pressure > 85 mm Hg and avoiding hypoxemia at least for 7 days following cervical SCI, and this level of monitoring and support should occur in the ICU.

Astragaloside IV ameliorates spinal cord injury through controlling ferroptosis in H2O2-damaged PC12 cells in vitro

“…SCI is a common presentation for spinal surgery, and its pathological process includes primary and secondary injuries (28). Secondary injury is a series of physiological and biochemical reactions such as ischemia, edema, and electrolyte disturbance on the basis of the primary injury (29,30). Ischemia, hypoxia, and inflammation can cause the production and release of ROS (31)(32)(33), which can lead to oxidative damage of local tissues, as well as apoptosis and AS-IV + si- necrosis of nerve cells (34).…”

Secondary damage management of acute traumatic spinal cord injury in low and middle-income countries: A survey on a global scale (Part III)

“…Amongst others, this includes the use of devices to monitor cardiovascular and respiratory functions, the management of hypotension and bradycardia associated with spinal shock, and the maintenance of an optimized mean arterial blood pressure to secure spinal cord perfusion ( Sánchez et al., 2020 ; Ryken et al., 2013 ; Roquilly et al., 2020 ; Hogg et al., 2021 ). Although dedicated Acute Spinal Cord Injury Centers have been shown to decrease overall mortality and the number and severity of complications, a general ICU setting is recommended as it provides adequate medical care after TSCI ( Parent et al., 2011 ; Schwartzbauer and Stein, 2016 ). Accordingly, nearly 80% of our sample stated to have access in their Institution to an ICU, with rates ranging from 74.5% (LICs) to 80.5% (L-MICs) when considering the income area and from 75% (ME&NA) to 81.8% (EA&P) when examining the geographic area (see Fig.…”