title: Mean Arterial Blood Pressure Management of Acute Traumatic Spinal Cord Injured Patients during the Pre-Hospital and Early Admission Period.
abstract: The optimization and maintenance of mean arterial blood pressure (MAP) and the general avoidance of systemic hypotension for the first 5-7 days following acute traumatic spinal cord injury (tSCI) is considered to be important for minimizing secondary spinal cord ischemic damage. The characterization of hemodynamic parameters in the immediate post-injury stage prior to admission to a specialized spine unit has not been previously reported. Here we describe the blood pressure management of 40 acute tSCI patients in the early post-injury phases of care prior to their arrival in a specialized spinal injury high dependency unit (HDU), intensive care unit (ICU), or operating room (OR). This study found that a significant proportion of these patients experience periods of relative hypotension prior to their admission to a specialized spinal unit. In particular, the mean calculated MAP was 78.8 mm Hg, with 52% of MAP measurements <80 mm Hg at primary receiving hospitals. Despite having a mean calculated MAP of 83.3 mm Hg in the emergency room of the tertiary hospital, 40% of the MAP measurements were <80 mm Hg. Although stringent monitoring and management of MAP may be facilitated and adhered to in a spinal HDU, ICU, or OR, it is important to recognize that acute traumatic SCI patients may experience many periods of relative hypotension prior to their arrival in such specialized units. This study highlights the need for education and awareness to optimize the hemodynamic management of acute SCI patients during the immediate post-injury period.
authors.affiliation: 1 Division of Neurosurgery, Department of Surgery, Vancouver Spine Surgery Institute, University of British Columbia , Blusson Spinal Cord Centre, Vancouver, British Columbia, Canada .
authors.forename: Jin W
authors.initials: JW
authors.lastname: Tee
authors.affiliation: 2 Vancouver Spine Program, Vancouver General Hospital , Vancouver, British Columbia, Canada .
authors.forename: Farhaan
authors.initials: F
authors.lastname: Altaf
authors.affiliation: 2 Vancouver Spine Program, Vancouver General Hospital , Vancouver, British Columbia, Canada .
authors.forename: Lise
authors.initials: L
authors.lastname: Belanger
authors.affiliation: 1 Division of Neurosurgery, Department of Surgery, Vancouver Spine Surgery Institute, University of British Columbia , Blusson Spinal Cord Centre, Vancouver, British Columbia, Canada .
authors.forename: Tamir
authors.initials: T
authors.lastname: Ailon
authors.affiliation: 3 Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia , Blusson Spinal Cord Centre, Vancouver, British Columbia, Canada .|4 International Collaboration on Repair Discoveries (ICORD) Blusson Spinal Cord Centre , Vancouver, British Columbia, Canada .
authors.forename: John
authors.initials: J
authors.lastname: Street
authors.affiliation: 1 Division of Neurosurgery, Department of Surgery, Vancouver Spine Surgery Institute, University of British Columbia , Blusson Spinal Cord Centre, Vancouver, British Columbia, Canada .
authors.forename: Scott
authors.initials: S
authors.lastname: Paquette
authors.affiliation: 1 Division of Neurosurgery, Department of Surgery, Vancouver Spine Surgery Institute, University of British Columbia , Blusson Spinal Cord Centre, Vancouver, British Columbia, Canada .
authors.forename: Michael
authors.initials: M
authors.lastname: Boyd
authors.affiliation: 3 Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia , Blusson Spinal Cord Centre, Vancouver, British Columbia, Canada .
authors.forename: Charles G
authors.initials: CG
authors.lastname: Fisher
authors.affiliation: 3 Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia , Blusson Spinal Cord Centre, Vancouver, British Columbia, Canada .|4 International Collaboration on Repair Discoveries (ICORD) Blusson Spinal Cord Centre , Vancouver, British Columbia, Canada .
authors.forename: Marcel F
authors.initials: MF
authors.lastname: Dvorak
authors.affiliation: 3 Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia , Blusson Spinal Cord Centre, Vancouver, British Columbia, Canada .|4 International Collaboration on Repair Discoveries (ICORD) Blusson Spinal Cord Centre , Vancouver, British Columbia, Canada .
authors.forename: Brian K
authors.initials: BK
authors.lastname: Kwon
mesh_terms: D000208:Acute Disease; D000328:Adult; D062186:Arterial Pressure / Q000502:physiology*; D005260:Female; D006801:Humans; D007022:Hypotension / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D013119:Spinal Cord Injuries / Q000150:complications / Q000628:therapy*; D055815:Young Adult
keywords: MAP; SCI; acute; cardiopulmonary; clinical guidelines; hemodynamic; hypotension; secondary injury