Pilot study: advanced haemodynamic monitoring after acute spinal cord injury‑Keep the pressure up?

BMC Anesthesiology, 2022 · DOI: https://doi.org/10.1186/s12871-022-01806-2 · Published: August 12, 2022

Spinal Cord Injury Critical Care Anesthesiology

Simple Explanation

Acute spinal cord injury can cause vasoplegia and bradycardia due to loss of sympathetic control. The severity depends on the injury level, with higher lesions causing more instability. This study aimed to show the haemodynamic profile of patients suffering from acute SCI over a longer period of time and unaffected by vasopressor use. The study used the PiCCO™ system for haemodynamic monitoring in patients with acute SCI, excluding factors like sepsis or heart failure to avoid biased results.

Study Duration

8 ± 5 days

Participants

30 patients with acute SCI

Evidence Level

Level II; Prospective, single-center pilot study

Key Findings

1
The study found that systemic vascular resistance index (SVRI) was significantly reduced compared to normal ranges in non-SCI patients, regardless of vasopressor use.
2
A mixed model analysis showed a significant negative relationship between norepinephrine treatment and MAP, SVRI, and GEDVI.
3
Cardiac index (CI), stroke volume index (SVI) and central venous pressure (CVP) were not significantly affected by vasopressor use.

Research Summary

This study investigated the haemodynamic profiles of patients with acute spinal cord injury (SCI) using the PiCCO™ system, focusing on data unaffected by vasopressor use and other confounding factors. The results indicated that the systemic vascular resistance index (SVRI) was lower than the reference range in SCI patients, irrespective of vasopressor use, and norepinephrine treatment had a negative correlation with MAP, SVRI, and GEDVI. The authors suggest that these findings could lead to an adaptation of target ranges for SVRI and MAP in acute SCI patients, potentially reducing vasopressor use and its associated complications.

Practical Implications

Adaptation of Target Ranges

The findings suggest an adaptation of target ranges for SVRI and MAP could be justified, potentially reducing the need for vasopressors.

Reduced Vasopressor Use

A more focused application and reduced dosage of vasopressors may be possible by adjusting target values for MAP and SVRI.

Early Mobilization

Lowering MAP goals may facilitate earlier mobilization of patients, reducing hospitalization times and complications.

Study Limitations

1
The neurological outcome of patients was not assessed.
2
Some haemodynamic measurements were performed while patients were ventilated and/or sedated.
3
The number of patients enrolled in the study was small.

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