Provision of nutrients after acute spinal cord injury: the implications of feast and famine

Garber, Sarah T.; Hawryluk, Gregory

doi:10.4103/1673-5374.160081

Cited by 2 publications

(2 citation statements)

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“…Our group recently validated this recommendation with a large dataset of high-frequency MAP measurements obtained from 100 SCI patients. We found that maintenance of MAP values above 85 mmHg correlated with improved neurological recovery 3,6 and that the benefit associated with MAP augmentation decreased over time. Importantly, we also found that the proportion of values <85 mmHg correlated more strongly with outcome than mean values suggesting that efforts to prevent even brief drops below threshold are important.…”

Section: Introductionmentioning

confidence: 65%

“…Secondary injury involves a complex and highly inter-related series of molecular processes such as ionic dysregulation, free radical production, cytoskeletal degradation, and neuroinflammation 3 . Despite what we have learned about secondary injury, we are as yet without a safe and effective therapeutic which attenuates these processes 3–5 . Physicians have been more successful treating secondary insults which occur at the level of the organism and include hypoxia, and hypotension 6–13 .…”

Section: Introductionmentioning

confidence: 99%

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Higher Mean Arterial Pressure Values Correlate with Neurologic Improvement in Patients with Initially Complete Spinal Cord Injuries

et al. 2016

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Background Traumatic spinal cord injury (SCI) guidelines recommend to maintain mean arterial pressures (MAPs) above 85 mmHg for 7d following SCI to minimize spinal cord ischemia. Some doubt that patients with initially complete injuries benefit. Objective To assess the relationship between MAP augmentation and neurological improvement in SCI patients stratified by initial AIS score. Methods High-frequency MAP values of acute SCI patients admitted over a six-year period were recorded and values were correlated with degree of neurological recovery in an analysis stratified by post-resuscitation AIS score. Results 62 patients with SCI were analyzed. 33 patients were determined to have complete injuries and of those 11 improved at least 1 AIS grade by discharge. The average MAP of initially AIS A patients who improved versus those who did not was significantly higher (96.6 +/− 0.07 mmHg vs 94.4 +/− 0.06 mmHg, respectively; p < 0.001) and the proportion of MAP values < 85mmHg was significantly lower (13.5% vs 25.6%, respectively; p<0.001). A positive correlation between MAP values and outcome was also observed in AIS B and C patients, but was not observed in patients who were initially AIS D. Conclusion A positive correlation was observed between MAP values and neurological recovery in AIS A, B and C patients but not AIS D patients. These data raise the possibility that patients with an initially complete SCI may derive greater benefit from MAP augmentation than patients with initial AIS D injuries.

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Section: Introductionmentioning

confidence: 65%