Impact of Mean Arterial Blood Pressure During the First Seven Days Post Spinal Cord Injury

Cohn, Jennifer A.; Wright, Jerry; McKenna, Stephen L.; Bushnik, Tamara

doi:10.1310/sci1503-096

Cited by 5 publications

(12 citation statements)

References 23 publications

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“…This study largely serves as the basis for the current guidelines for the acute cardiovascular management of patients with SCIs. 12,13 Cohn and coworkers 14 more recently reported a retrospective study of the relationship between episodes of hypotension noted in the medical record and outcomes using step-wise regression, and concluded that there may be a threshold of around 70 mm Hg below which worse outcomes are seen. This study involved only 17 patients and had less accurate data on brief periods of hypotension, but its results are in accordance with our findings (Fig.…”

Section: Literature To Datementioning

confidence: 99%

“…These recommendations were essentially unchanged in the 2013 update of the guidelines. 13 A small, heterogenous group of uncontrolled, underpowered studies supports this recommendation 14 ; to date, no study provides better than class III evidence supporting blood pressure augmentation for acute SCI. In all relevant publications to date, blood pressure augmentation was merely part of an aggressive management protocol confounding the relationship between MAP and outcome.…”

mentioning

confidence: 99%

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Mean Arterial Blood Pressure Correlates with Neurological Recovery after Human Spinal Cord Injury: Analysis of High Frequency Physiologic Data

Hawryluk

Whetstone

Saigal

et al. 2015

Journal of Neurotrauma

199

169

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Current guidelines for the care of patients with acute spinal cord injuries (SCIs) recommend maintaining mean arterial pressure (MAP) values of 85-90 mm Hg for 7 days after an acute SCI however, little evidence supports this recommendation. We sought to better inform the relationship between MAP values and neurological recovery. A computer system automatically collected and stored q1 min physiological data from intensive care unit monitors on patients with SCI over a 6-year period. Data for 100 patients with acute SCI were collected. 74 of these patients had American Spinal Injury Association Impairment Scale (AIS) grades determined by physical examination on admission and at time of hospital discharge. Average MAP values as well as the proportion of MAP values below thresholds were explored for values from 120 mm Hg to 40 mm Hg in 1 mm Hg increments; the relationship between these measures and outcome was explored at various time points up to 30 days from the time of injury. A total of 994,875 q1 min arterial line blood pressure measurements were recorded for the included patients amid 1,688,194 min of recorded intensive care observations. A large proportion of measures were below 85 mm Hg despite generally acceptable average MAP values. Higher average MAP values correlated with improved recovery in the first 2-3 days after SCI while the proportion of MAP values below the accepted threshold of 85 mm Hg seemed a stronger correlate, decreasing in strength over the first 5-7 days after injury. This study provides strong evidence supporting a correlation between MAP values and neurological recovery. It does not, however, provide evidence of a causal relationship. Duration of hypotension may be more important than average MAP. It provides support for the notion of MAP thresholds in SCI recovery, and the highest MAP values correlated with the greatest degree of neurological recovery. The results are concordant with current guidelines in suggesting that MAP thresholds >85 mm Hg may be appropriate after acute SCI.

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Section: Literature To Datementioning

confidence: 99%

mentioning

confidence: 99%

Mean Arterial Blood Pressure Correlates with Neurological Recovery after Human Spinal Cord Injury: Analysis of High Frequency Physiologic Data

Hawryluk

Whetstone

Saigal

et al. 2015

Journal of Neurotrauma

199

169

View full text Add to dashboard Cite

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“…This study extends the window of analysis beyond discharge from hospitalization to discharge from inpatient rehabilitation. Previous work from our group demonstrated an ICU MAP range that corresponded with optimal motor recovery [8,17,19]. The current analysis presented here focuses specifically on intraoperative MAP exposure and exploring the deleterious effects of both hypotension, as well as hypertension, on motor recovery.…”

Section: Discussionmentioning

confidence: 99%

“…Due to the complex nature of SCI pathophysiology, we developed an analytical workflow according to the same statistical principals as our previous methods to account for the heterogeneity of this disorder [9,[23][24][25][26]. For the current study, the workflow begins with a sequential evaluation of motor recovery in comparison to time within a predefined series of blood pressure parameters, which is similar to previous studies [17,19]. This allows for visualizing the relationship between changes in ISNCSCI motor score versus time spent within defined MAP range.…”

Section: Discussionmentioning

confidence: 99%

“…Although these postinjury MAP goals are widely accepted, there is a paucity of evidence to support this practice [14][15][16]. Furthermore, alternatives to the 85-90 mmHg MAP range have been proposed [8,[17][18][19][20][21]. Taken together, the current available evidence indicates a continued need for studies to inform MAP augmentation targets that maximize neurologic recovery following traumatic SCI.…”

Section: Introductionmentioning

confidence: 99%

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Exploration of surgical blood pressure management and expected motor recovery in individuals with traumatic spinal cord injury

et al. 2019

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Study design Retrospective analysis. Objective To assess the impact of mean arterial blood pressure (MAP) during surgical intervention for spinal cord injury (SCI) on motor recovery. Setting Level-one Trauma Hospital and Acute Rehabilitation Hospital in San Jose, CA, USA. Methods Twenty-five individuals with traumatic SCI who received surgical and acute rehabilitation care at a level-one trauma center were included in this study. The Surgical Information System captured intraoperative MAPs on a minute-byminute basis and exposure was quantified at sequential thresholds from 50 to 104 mmHg. Change in International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) motor score was calculated based on physiatry evaluations at the earliest postoperative time and at discharge from acute rehabilitation. Linear regression models were used to estimate the rate of recovery across the entire MAP range. Results An exploratory analysis revealed that increased time within an intraoperative MAP range (70-94 mmHg) was associated with ISNCSCI motor score improvement. A significant regression equation was found for the MAP range 70-94 mmHg (F[1, 23] = 4.65, r 2 = 0.168, p = 0.042). ISNCSCI motor scores increased 0.036 for each minute of exposure to the MAP range 70-94 mmHg during the operative procedure; this represents a significant correlation between intraoperative time with MAP 70-94 and subsequent motor recovery. Blood pressure exposures above or below this range did not display a positive association with motor recovery. Conclusions Hypertension as well as hypotension during surgery may impact the trajectory of recovery in individuals with SCI, and there may be a direct relationship between intraoperative MAP and motor recovery.

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The Impact of Mean Arterial Pressure on Functional Outcome Post Trauma-Related Acute Spinal Cord Injury: A Scoping Systematic Review of the Human Literature

Sabit

Zeiler

Berrington

2016

J Intensive Care Med

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Impact of Mean Arterial Blood Pressure During the First Seven Days Post Spinal Cord Injury

Cited by 5 publications

References 23 publications

Mean Arterial Blood Pressure Correlates with Neurological Recovery after Human Spinal Cord Injury: Analysis of High Frequency Physiologic Data

Mean Arterial Blood Pressure Correlates with Neurological Recovery after Human Spinal Cord Injury: Analysis of High Frequency Physiologic Data

Exploration of surgical blood pressure management and expected motor recovery in individuals with traumatic spinal cord injury

The Impact of Mean Arterial Pressure on Functional Outcome Post Trauma-Related Acute Spinal Cord Injury: A Scoping Systematic Review of the Human Literature

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