Vasopressor Use in Acute Spinal Cord Injury: Current Evidence and Clinical Implications

J. Clin. Med., 2025 · DOI: https://doi.org/10.3390/jcm14030902 · Published: January 29, 2025

Spinal Cord Injury Cardiovascular Science Pharmacology

Simple Explanation

Acute spinal cord injury can cause severe neurological issues, where blood pressure instability worsens the damage. Maintaining sufficient blood flow to the spinal cord is crucial. Vasopressors are often used to stabilize blood pressure, but there's debate on the best blood pressure targets and which vasopressor to use. Updated guidelines suggest a mean arterial pressure (MAP) range of 75–80 mmHg (lower limit) and 90–95 mmHg (upper limit) for the initial 3–7 days post-injury. Norepinephrine is often preferred due to its balanced effects on blood vessels and spinal cord blood flow. However, vasopressors can cause heart problems, so careful selection based on individual patient needs is necessary. Further research is needed.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Level III Review

Key Findings

1
Updated guidelines suggest a broader MAP target range of 75–80 mmHg as the lower limit and 90–95 mmHg as the upper limit for 3–7 days of treatment post-SCI.
2
Maintaining adequate MAP has been strongly associated with improvements in the AIS motor subscore, with emerging evidence suggesting potential benefits for sensory subscores.
3
Norepinephrine is frequently the first-line vasopressor in acute SCI management due to its potent alpha-adrenergic agonist effects, which increase peripheral vascular resistance.

Research Summary

This review explores updated guidelines and current evidence regarding MAP management and the use of vasopressors in SCI, focusing on their impact on spinal cord perfusion and neurologic outcomes. Recent studies highlight the role of durotomy in directly improving spinal cord perfusion pressure (SCPP) by reducing intraspinal pressure (ISP), offering a complementary mechanical intervention as part of pharmacologic therapies. Further research is needed to refine vasopressor use and establish evidence-based protocols that optimize neurologic recovery, alongside continued exploration of SCPP as a potential therapeutic target.

Practical Implications

Personalized Hemodynamic Management

Clinicians should tailor MAP goals based on individual patient needs and clinical circumstances, considering factors like injury severity and comorbidities.

SCPP as a Therapeutic Target

Continued exploration of SCPP monitoring techniques and mechanical interventions like duroplasty, alongside vasopressor use, is needed to better define their roles in optimizing outcomes for SCI patients.

Vasopressor Selection

The choice of vasopressor should be tailored to the patient’s specific clinical condition, considering the level and severity of injury, the presence of cardiopulmonary dysfunction, and comorbidities.

Study Limitations

1
The optimal SCPP target range is still under investigation.
2
Current guidelines are predominantly derived from studies focusing on traumatic cervical SCIs, leaving gaps in understanding optimal hemodynamic management for other injury mechanisms and levels.
3
Most studies report associations rather than causative relationships between MAP thresholds and recovery outcomes.

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