Vasopressor administration in spinal cord injury: should we apply a universal standard to all injury patterns?

Readdy, William J; Dhall, Sanjay S.

doi:10.4103/1673-5374.179051

Cited by 10 publications

(1 citation statement)

References 10 publications

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“…Physicians will order vasopressors following traumatic SCIs to keep the mean arterial pressure (MAP) above 85 mmHg in accordance with the American Association of Neurological Surgeons / Congress of Neurological Surgeons recommendation to increase perfusion to the spinal cord [ 13 , 14 ]. However, in doing so, vasopressor administration constricts peripheral vasculature reducing blood circulation to the skin which may increase susceptibility to PI formation [ 8 ], for patients with SCI [ 15 , 16 ]. The choice of vasopressor therapy and their inherent pharmacological differences could offer a causative explanation of PI development if indeed there is an association with these.…”

Section: Introductionmentioning

confidence: 99%

Predictors of hospital-acquired pressure injuries in patients with complete spinal cord injury: a retrospective case–control study

Balasuberamaniam

Wasim

Shrikumar

et al. 2023

BMC Musculoskelet Disord

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Background Despite current best practices, pressure injuries (PI) remain a devastating and prevalent hospital-acquired complication for patients with acute traumatic spinal cord injuries (SCIs). This study examined associations between risk factors for PI development in patients with complete SCI, such as norepinephrine dose and duration, and other demographic factors or lesion characteristics. Methods This case–control study included adults with acute complete SCIs ASIA-A, who were admitted to a level-one trauma center between 2014–18. A retrospective review was implement using data on patient and injury characteristics, including age, gender, level of SCI (cervical vs. thoracic), Injury Severity Score (ISS), length of stay (LOS) and mortality; presence/absence of PI during their acute hospital stay; and treatment factors such as spinal surgery, mean arterial pressure (MAP) targets, and vasopressor treatment. Multivariable logistic regression evaluated associations with PI. Results Eighty-two out of 103 eligible patients had complete data, and 30 (37%) developed PIs. Patient and injury characteristics, including age (Mean: 50.6; SD:21.3), location of SCI (48 cervical, 59%) and ISS (Mean 33.1; SD:11.8), did not differ between PI and non-PI groups. Logistic regression analysis revealed that male gender (OR:34.1; CI95:2.3–506.5, p = 0.010) and increased LOS (log-transformed; OR:20.5, CI95:2.8–149.9, p = 0.003) were associated with increased risk of PI. Having an order for a MAP > 80mmg (OR:0.05; CI95:0.01–0.30, p = 0.001) was associated with a reduced risk of PI. There were no significant associations between PI and duration of norepinephrine treatment. Conclusions Norepinephrine treatment parameters were not associated with development of PI, suggesting that MAP targets should be a focus for future investigations for SCI management. Increasing LOS should highlight the need for high-risk PI prevention and vigilance.

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