Article

Prospective observational study of acute spinal cord-injured (SCI)
patients.Objectives:To determine how effectively mean arterial blood pressure
(MAP) and spinal cord perfusion pressure (SCPP) are maintained at target levels
in acute SCI patients.Setting:Single-institution study at a Canadian level-one
trauma center.Methods:Twenty-one individuals with cervical or thoracic SCI were
enrolled within 48 h of injury. A lumbar intrathecal drain was inserted for
monitoring intrathecal cerebrospinal fluid pressure (ITP). The MAP was monitored
concurrently with ITP, and the SCPP was calculated. Data was recorded hourly from
the time of first assessment until at least the end of the 5th day post
injury.Results:All subjects had at least one recorded episode with a MAP below 80
mm Hg, and 81% had at least one episode with a MAP below 70 mm Hg. On average,
subjects with cervical injuries had 18.4% of their pressure recordings below 80
mm Hg. Subjects with thoracic cord injuries had on average 35.9% of their MAP
recordings <80 mm Hg.Conclusion:It is common practice to establish MAP targets
for optimizing cord perfusion in acute SCI. This study suggests that even in an
acute SCI referral center, when prospectively scrutinized, the actual MAP may
frequently fall below the intended targets. Such results raise awareness of the
vigilance that must be kept in the hemodynamic management of these patients, and
the potential discrepancy between routinely setting target MAP according to
'practice guidelines' and actually achieving them.

Langue : ANGLAIS