title: A prospective evaluation of hemodynamic management in acute spinal cord injury patients.
abstract: METHODS
  Prospective observational study of acute spinal cord-injured (SCI) patients.
  
  
  OBJECTIVE
  To determine how effectively mean arterial blood pressure (MAP) and spinal cord perfusion pressure (SCPP) are maintained at target levels in acute SCI patients.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: C Y
authors.initials: CY
authors.lastname: Kong
authors.forename: A M
authors.initials: AM
authors.lastname: Hosseini
authors.forename: L M
authors.initials: LM
authors.lastname: Belanger
authors.forename: J J
authors.initials: JJ
authors.lastname: Ronco
authors.forename: S J
authors.initials: SJ
authors.lastname: Paquette
authors.forename: M C
authors.initials: MC
authors.lastname: Boyd
authors.forename: N
authors.initials: N
authors.lastname: Dea
authors.forename: J
authors.initials: J
authors.lastname: Street
authors.forename: C G
authors.initials: CG
authors.lastname: Fisher
authors.forename: M F
authors.initials: MF
authors.lastname: Dvorak
authors.forename: B K
authors.initials: BK
authors.lastname: Kwon
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D002170:Canada; D002408:Catheters, Indwelling; D015170:Cerebrospinal Fluid Pressure / Q000502:physiology*; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D013119:Spinal Cord Injuries / Q000150:complications / Q000503:physiopathology*; D055815:Young Adult