AA

Hemodynamic Management

The available evidence to date regarding hemodynamic management during the acute phase of SCI has focused on the effectiveness of early aggressive support on neurological outcomes.

Early Hemodynamic Management during Acute SCI

Discussion

Two studies have examined the effect of early aggressive hemodynamic management on neurological improvement over time following SCI. In a study by Vale et al. (1997), 64 patients were treated with aggressive hemodynamic support as needed to maintain a MAP above 85 mmHg while in the ICU. Medical management included the use of arterial BP catheters, Swan-Ganz pulmonary artery catheters, intravenous fluids, colloid, and vasopressors. Surgery was also performed for decompression and stabilization. Treatment was initiated early after injury, beginning within 36 hours of sustaining SCI, and follow-up examinations were performed at 6, 12, and 18 month intervals. Improvement by at least 1 American Spinal Injury Assessment (ASIA) grade was seen in 60% of patients with complete cervical SCI and 33% of patients with complete thoracic SCI at the time of their last examination. Improvement in neurological function after 1 year following injury was observed in 92% of patients with incomplete cervical SCI and 88% of patients with incomplete thoracic SCI.

A similar study by Levi et al. (1993) examined 50 patients with cervical SCI who went through invasive hemodynamic monitoring and support during their ICU stay, beginning within the first week of injury. The treatment protocol included the use of arterial line and Swan-Ganz catheters, fluid replacement, operative stabilization, and dopamine and/or dobutamine as necessary to maintain a MAP of more than 90 mmHg. At 6 weeks following injury, improvement in neurological function was observed in 40% of patients, and remained the same in 42% of patients.

Conclusion

There is level 4 evidence (from two pre-post studies; Vale et al. 1997; Levi et al. 1993) that aggressive hemodynamic support in acute SCI patients may lead to improved neurological function. 

  • Hemodynamic support during the acute phase post SCI may be effective in improving neurological outcomes.