Variability in the Treatment of Acute Spinal Cord Injury in the United Kingdom: Results of a National Survey

Werndle, Melissa C.; Zoumprouli, Argyro; Sedgwick, Philip; Papadopoulos, Marios C.

doi:10.1089/neu.2011.2038

Cited by 52 publications

(53 citation statements)

References 31 publications

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“…There were no ISP or SCPP targets in our studies because we have not yet determined the optimal ISP and SCPP after TSCI. Currently, in the UK, arterial blood pressure management after TSCI is variable, 27 whereas in the US the guidelines of the American Association of Neurological Surgeons of 85-90 mm Hg MAP are usually followed. 25 Intervening to elevate the blood pressure without monitoring ISP and SCPP from the injury site is potentially dangerous due to cardiogenic complications.…”

Section: Discussionmentioning

confidence: 99%

“…In the UK, such MAP management is variable. 27 For the next 14 patients, a norepinephrine infusion was administered to support a target MAP of more than 80 mm Hg. Serum lactate and base excess were checked via arterial blood gas analysis at least 3 times per day to assess end-organ ischemia.…”

Section: Inotropes and Target Mapmentioning

confidence: 99%

“…As a result, the surgical and anesthetic management of TSCI is variable. 27 In 2008, we showed that intraspinal pressure (ISP) is elevated after TSCI at the injury site in mice. 22 We subsequently introduced a technique to monitor ISP in patients with TSCI and thus compute spinal cord perfusion pressure (SCPP) as MAP minus ISP.…”

mentioning

confidence: 99%

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Safety profile and probe placement accuracy of intraspinal pressure monitoring for traumatic spinal cord injury: Injured Spinal Cord Pressure Evaluation study

Phang

Zoumprouli

Saadoun

et al. 2016

SPI

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OBJECTIVE A novel technique for monitoring intraspinal pressure and spinal cord perfusion pressure in patients with traumatic spinal cord injury was recently described. This is analogous to monitoring intracranial pressure and cerebral perfusion pressure in patients with traumatic brain injury. Because intraspinal pressure monitoring is a new technique, its safety profile and impact on early patient care and long-term outcome after traumatic spinal cord injury are unknown. The object of this study is to review all patients who had intraspinal pressure monitoring to date at the authors' institution in order to define the accuracy of intraspinal pressure probe placement and the safety of the technique. METHODS At the end of surgery to fix spinal fractures, a pressure probe was inserted intradurally to monitor intraspinal pressure at the injury site. Postoperatively, CT scanning was performed within 48 hours and MRI at 2 weeks and 6 months. Neurointensive care management and complications were reviewed. The American Spinal Injury Association Impairment Scale (AIS) grade was determined on admission and at 2 to 4 weeks and 12 to 18 months postoperation. RESULTS To date, 42 patients with severe traumatic spinal cord injuries (AIS Grades A–C) had undergone intraspinal pressure monitoring. Monitoring started within 72 hours of injury and continued for up to a week. Based on postoperative CT and MRI, the probe position was acceptable in all patients, i.e., the probe was located at the site of maximum spinal cord swelling. Complications were probe displacement in 1 of 42 patients (2.4%), CSF leakage that required wound resuturing in 3 of 42 patients (7.1%), and asymptomatic pseudomeningocele that was diagnosed in 8 of 42 patients (19.0%). Pseudomeningocele was diagnosed on MRI and resolved within 6 months in all patients. Based on the MRI and neurological examination results, there were no serious probe-related complications such as meningitis, wound infection, hematoma, wound breakdown, or neurological deterioration. Within 2 weeks postoperatively, 75% of patients were extubated and 25% underwent tracheostomy. Norepinephrine was used to support blood pressure without complications. Overall, the mean intraspinal pressure was around 20 mm Hg, and the mean spinal cord perfusion pressure was around 70 mm Hg. In laminectomized patients, the intraspinal pressure was significantly higher in the supine than lateral position by up to 18 mm Hg after thoracic laminectomy and 8 mm Hg after cervical laminectomy. At 12 to 18 months, 11.4% of patients had improved by 1 AIS grade and 14.3% by at least 2 AIS grades. CONCLUSIONS These data suggest that after traumatic spinal cord injury intradural placement of the pressure probe is accurate and intraspinal pressure monitoring is safe for up to a week. In patients with spinal cord injury who had laminectomy, the supine position should be avoided in order to prevent rises in intraspinal pressure.

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Section: Discussionmentioning

confidence: 99%

Section: Inotropes and Target Mapmentioning

confidence: 99%

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Safety profile and probe placement accuracy of intraspinal pressure monitoring for traumatic spinal cord injury: Injured Spinal Cord Pressure Evaluation study

Phang

Zoumprouli

Saadoun

et al. 2016

SPI

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“…Furthermore, the National Institutes of Health (NIH) Roadmap expands the process of moving new innovations into practice by describing the additional research laboratory of practice-based research as the needed translational step to improve incorporation of discoveries into the front line of clinical care. 7 In the field of spinal cord injury (SCI), the literature reports variability in all aspects of care, including acute clinical care, 8 the management of chronic pain 9 as well as expectations regarding outcomes given by clinicians to patients. 10 There are multiple challenges in a field such as SCI to identify and implement evidence-based practices.…”

Section: Introductionmentioning

confidence: 99%

Knowledge translation and implementation in spinal cord injury: a systematic review

et al. 2014

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,5 and the SCIRE Research TeamObjective: To conduct a systematic review examining the effectiveness of knowledge translation (KT) interventions in changing clinical practice and patient outcomes. Methods: MEDLINE/PubMed, CINAHL, EMBASE and PsycINFO were searched for studies published from January 1980 to July 2012 that reported and evaluated an implemented KT intervention in spinal cord injury (SCI) care. We reviewed and summarized results from studies that documented the implemented KT intervention, its impact on changing clinician behavior and patient outcomes as well as the facilitators and barriers encountered during the implementation. Results: A total of 13 articles featuring 10 studies were selected and abstracted from 4650 identified articles. KT interventions included developing and implementing patient care protocols, providing clinician education and incorporating outcome measures into clinical practice. The methods (or drivers) to facilitate the implementation included organizing training sessions for clinical staff, introducing computerized reminders and involving organizational leaders. The methodological quality of studies was mostly poor. Only 3 out of 10 studies evaluated the success of the implementation using statistical analyses, and all 3 reported significant behavior change. Out of the 10 studies, 6 evaluated the effect of the implementation on patient outcomes using statistical analyses, with 4 reporting significant improvements. The commonly cited facilitators and barriers were communication and resources, respectively. Conclusion: The field of KT in SCI is in its infancy with only a few relevant publications. However, there is some evidence that KT interventions may change clinician behavior and improve patient outcomes. Future studies should ensure rigorous study methods are used to evaluate KT interventions.

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“…Treatment results of patients with spinal cord injury are still poor despite various treatment approach and efforts. The aim of the entire treatment effort is to prevent secondary tissue damage [3][4][5]. There are reports suggesting that LiCl protects the cultured neurons against glutamateinduced excitotoxicity and apoptosis mediated by N-methyl-D-aspartate (NMDA) receptors [6].…”

Section: Introductionmentioning

confidence: 99%

Effects of lithium chloride and methylprednisolone on experimental spinal cord injury

Ekici¹,

Özbek²,

Incedal³

et al. 2016

Eur Res J

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Objectives. Antioxidant effects of lithium chloride (LiCl) and methylprednisolone were investigated in an experimental spinal cord injury. Methods. Spinal cord injury was performed by cerebral vascular clip with a closing force of 40 g; the duration of epidural compression was 30 seconds after T9-11 total laminectomy in the rat spine. The study was conducted in 4 groups. Group 1: sham (n=8), group 2: 0.9% saline (n=8), group 3: LiCl (n=8), group 4: methylprednisolone (n=8). Ketamine (60 mg/kg) and 2% xylazine (5 mg/kg) were used intraperitoneally as anesthesia protocol for the groups. The rats were sacrificed 24 hours after the injury and blood samples were taken. Total oxidant status (TOS), total antioxidant status (TAS), malondialdehyde (MDA) and tumor necrosis factor-α (TNF-α) level were analyzed. Results. Median (q1-q3) levels of TAS, TOS, MDA and TNF-α were statistically analyzed for the study groups. The TAS values of LiCl yielded statistically significant differences compared with group 1, 2 and 4 (p<0.05). The MDA values of LiCl and methylprednisolone groups were found to significantly differ between the sham and saline groups (p<0.05). There were no statistical differences between the study groups for the TNF-α and TOS values (p>0.05). Conclusions. LiCl seems to be an effective drug for experimental spinal cord injuries.Eur Res J 2016;2(3):165-169

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Variability in the Treatment of Acute Spinal Cord Injury in the United Kingdom: Results of a National Survey

Cited by 52 publications

References 31 publications

Safety profile and probe placement accuracy of intraspinal pressure monitoring for traumatic spinal cord injury: Injured Spinal Cord Pressure Evaluation study

Safety profile and probe placement accuracy of intraspinal pressure monitoring for traumatic spinal cord injury: Injured Spinal Cord Pressure Evaluation study

Knowledge translation and implementation in spinal cord injury: a systematic review

Effects of lithium chloride and methylprednisolone on experimental spinal cord injury

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