Optimization of the mean arterial pressure and timing of surgical decompression in traumatic spinal cord injury: a retrospective study

Dakson, Ayoub; Brandman, David M.; Thibault-Halman, Ginette; Christie, Sean

doi:10.1038/sc.2017.52

Cited by 54 publications

(47 citation statements)

References 39 publications

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“…Dakson et al 11 retrospectively reviewed 94 patients who presented with SCI between 2006 and 2010. Serial hourly MAPs were collected for 50 of these patients.…”

Section: Relationship Of Map Goals To Outcomesmentioning

confidence: 99%

The impact of blood pressure management after spinal cord injury: a systematic review of the literature

Saadeh

Smith

Joseph

et al. 2017

Neurosurgical Focus

111

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OBJECTIVESpinal cord injury (SCI) results in significant morbidity and mortality. Improving neurological recovery by reducing secondary injury is a major principle in the management of SCI. To minimize secondary injury, blood pressure (BP) augmentation has been advocated. The objective of this study was to review the evidence behind BP management after SCI.METHODSThis systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Using the PubMed database, the authors identified studies that investigated BP management after acute SCI. Information on BP goals, duration of BP management, vasopressor selection, and neurological outcomes were analyzed.RESULTSEleven studies that met inclusion criteria were identified. Nine studies were retrospective, and 2 were single-cohort prospective investigations. Of the 9 retrospective studies, 7 reported a goal mean arterial pressure (MAP) of higher than 85 mm Hg. For the 2 prospective studies, the MAP goals were higher than 85 mm Hg and higher than 90 mm Hg. The duration of BP management varied from more than 24 hours to 7 days in 6 of the retrospective studies that reported the duration of treatment. In both prospective studies, the duration of treatment was 7 days. In the 2 prospective studies, neurological outcomes were stable to improved with BP management. The retrospective studies, however, were contradictory with regard to the correlation of BP management and outcomes. Dopamine, norepinephrine, and phenylephrine were the agents that were frequently used to augment BP. However, more complications have been associated with dopamine use than with the other vasopressors.CONCLUSIONSThere are no high-quality data regarding optimal BP goals and duration in the management of acute SCI. Based on the highest level of evidence available from the 2 prospective studies, MAP goals of 85–90 mm Hg for a duration of 5–7 days should be considered. Norepinephrine for cervical and upper thoracic injuries and phenylephrine or norepinephrine for mid- to lower thoracic injuries should be considered.

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“…Dakson et al 11 retrospectively reviewed 94 patients who presented with SCI between 2006 and 2010. Serial hourly MAPs were collected for 50 of these patients.…”

Section: Relationship Of Map Goals To Outcomesmentioning

confidence: 99%

The impact of blood pressure management after spinal cord injury: a systematic review of the literature

Saadeh

Smith

Joseph

et al. 2017

Neurosurgical Focus

111

View full text Add to dashboard Cite

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“…31 Long standing human literature similarly supports maintenance of MAP at about 85 mm Hg for 5-7 days after traumatic spinal cord injury to minimize ischemia and/or additional secondary injury. [32][33][34] Intraoperative MAP was purposefully maintained at a minimum of 80-90 mm Hg throughout surgery in this dog by the use of pressors, and postoperative neurological deterioration was minor and transient. Intraoperative hypotension during ventral slot was associated with 23 times greater likelihood of a postoperative adverse event in dogs.…”

Section: Discussionmentioning

confidence: 96%

Remission after complete excision of an intramedullary hemangioma with an identifiable tumor plane in a dog

et al. 2019

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Objective To describe the use of an identifiable tumor plane (ITP) during myelotomy to excise an intramedullary hemangioma in a dog and report the outcome. Study design Case report. Animals One 5.5‐year‐old 42.9‐kg spayed female Leonberger dog. Methods Clinical signs included progressive proprioceptive deficits of both pelvic limbs. Magnetic resonance imaging was consistent with a dorsal intramedullary mass at L3‐L4. A laminectomy of the third and fourth lumbar vertebrae provided access for dorsal myelotomy. A clear surgical ITP was identified between the intramedullary mass and the spinal cord facilitating complete surgical resection. Results Histopathological examination was consistent with a hemangioma. Postoperative MRI was consistent with complete excision of the mass. No evidence of recurrence was found by MRI at 3 months and at 22 months after surgery. Mild proprioceptive deficits persisted in the right pelvic limb. Conclusion A clear ITP was present, and gross‐total resection (GTR) was achieved without significant morbidity. Persistent clinical remission resulted from surgery as the sole therapy. Clinical significance For an intramedullary tumor, GTR is the absence of visible tumor on intraoperative inspection combined with the absence of intramedullary contrast enhancement on postoperative MRI. When an ITP is present, GTR and resultant long‐term remission may be more likely.

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“…21 While some studies recommend MAP maintenance for at least 7 days post-injury, others have demonstrated improved neurologic recovery with just 5 days of MAP maintenance. [23][24][25] However, persistently elevated blood pressure has multiple effects and can amplify edema through the injured blood-brain barrier. 21 A weakness of relying solely on MAP is a lack of means to directly calculate the tissue resistance to perfusion.…”

Section: Pathophysiology Newly Injured Patientsmentioning

confidence: 99%

Cardiovascular Autonomic Dysfunction in Spinal Cord Injury: Epidemiology, Diagnosis, and Management

et al. 2020

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Spinal cord injury (SCI) disrupts autonomic circuits and impairs synchronistic functioning of the autonomic nervous system, leading to inadequate cardiovascular regulation. Individuals with SCI, particularly at or above the sixth thoracic vertebral level (T6), often have impaired regulation of sympathetic vasoconstriction of the peripheral vasculature and the splanchnic circulation, and diminished control of heart rate and cardiac output. In addition, impaired descending sympathetic control results in changes in circulating levels of plasma catecholamines, which can have a profound effect on cardiovascular function. Although individuals with lesions below T6 often have normal resting blood pressures, there is evidence of increases in resting heart rate and inadequate cardiovascular response to autonomic provocations such as the head-up tilt and cold face tests. This manuscript reviews the prevalence of cardiovascular disorders given the level, duration and severity of SCI, the clinical presentation, diagnostic workup, short- and long-term consequences, and empirical evidence supporting management strategies to treat cardiovascular dysfunction following a SCI.

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Optimization of the mean arterial pressure and timing of surgical decompression in traumatic spinal cord injury: a retrospective study

Cited by 54 publications

References 39 publications

The impact of blood pressure management after spinal cord injury: a systematic review of the literature

The impact of blood pressure management after spinal cord injury: a systematic review of the literature

Remission after complete excision of an intramedullary hemangioma with an identifiable tumor plane in a dog

Cardiovascular Autonomic Dysfunction in Spinal Cord Injury: Epidemiology, Diagnosis, and Management

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