title: Higher Mean Arterial Pressure Values Correlate with Neurologic Improvement in Patients with Initially Complete Spinal Cord Injuries.
abstract: BACKGROUND
  Traumatic spinal cord injury (SCI) guidelines recommend to maintain mean arterial pressures (MAPs) above 85 mm Hg for 7 days following SCI to minimize spinal cord ischemia. Some physicians doubt that patients with initially complete injuries benefit.
  
  
  OBJECTIVE
  To assess the relationship between MAP augmentation and neurologic improvement in SCI patients stratified by initial American Spinal Injury Association Impairment Scale (AIS) score.
  
  
  METHODS
  High-frequency MAP values of acute SCI patients admitted over a 6-year period were recorded, and values were correlated with degree of neurologic recovery in an analysis stratified by postresuscitation AIS score.
  
  
  RESULTS
  Sixty-two patients with SCI were analyzed. Thirty-three patients were determined to have complete injuries, and of those 11 improved at least 1 AIS grade by discharge. The average MAP of initially AIS A patients who improved versus those who did not was significantly higher (96.6 ± 0.07 mm Hg vs. 94.4 ± 0.06 mm Hg, respectively; P < 0.001), and the proportion of MAP values <85 mm Hg was significantly lower (13.5% vs. 25.6%, respectively; P < 0.001). A positive correlation between MAP values and outcome was also observed in AIS B and C patients but was not observed in patients who were initially AIS D.
  
  
  CONCLUSIONS
  A positive correlation was observed between MAP values and neurologic recovery in AIS A, B, and C patients but not AIS D patients. These data raise the possibility that patients with an initially complete SCI may derive greater benefit from MAP augmentation than patients with initial AIS D injuries.
authors: Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
authors: Joshua Stephen
authors: JS
authors: Catapano
authors: Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA; Brain and Spinal Cord Injury Center, University of California, San Francisco, California, USA; Department of Neurosurgery, University of California, San Francisco, California, USA. Electronic address: gregory.hawryluk@hsc.utah.edu.
authors: Gregory William
authors: GW
authors: John Hawryluk
authors: Department of Emergency Medicine, University of California, San Francisco, California, USA.
authors: William
authors: W
authors: Whetstone
authors: Department of Neurosurgery, University of Washington, Seattle, Washington, USA.
authors: Rajiv
authors: R
authors: Saigal
authors: Brain and Spinal Cord Injury Center, University of California, San Francisco, California, USA; Department of Neurosurgery, University of California, San Francisco, California, USA.
authors: Adam
authors: A
authors: Ferguson
authors: Department of Radiology, University of California, San Francisco, California, USA.
authors: Jason
authors: J
authors: Talbott
authors: Brain and Spinal Cord Injury Center, University of California, San Francisco, California, USA; Department of Neurosurgery, University of California, San Francisco, California, USA.
authors: Jacqueline
authors: J
authors: Bresnahan
authors: Brain and Spinal Cord Injury Center, University of California, San Francisco, California, USA; Department of Neurosurgery, University of California, San Francisco, California, USA.
authors: Sanjay
authors: S
authors: Dhall
authors: Department of Anaesthesia, University of California, San Francisco, California, USA.
authors: Jonathan
authors: J
authors: Pan
authors: Brain and Spinal Cord Injury Center, University of California, San Francisco, California, USA; Department of Neurosurgery, University of California, San Francisco, California, USA.
authors: Michael
authors: M
authors: Beattie
authors: Brain and Spinal Cord Injury Center, University of California, San Francisco, California, USA; Department of Neurosurgery, University of California, San Francisco, California, USA.
authors: Geoffrey
authors: G
authors: Manley
mesh_terms: D000328:Adult; D062186:Arterial Pressure; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D013119:Spinal Cord Injuries / Q000503:physiopathology / Q000628:therapy*; D020760:Spinal Cord Ischemia / Q000503:physiopathology / Q000517:prevention & control*; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents
keywords: Blood pressure; Complete; Outcome; Spinal cord injury; Trauma