Early Hemodynamic Management during Acute SCI

Author Year
Country
Research Design
Sample Size

Methods Outcomes
 

Vale et al. (1997)
USA
Pre-Post
N=64

Population: Gender: males=29, females=6 (cervical SCI), males=25, females=4 (thoracic SCI); Level of injury: cervical (C3-C7), thoracic (T4-T12); Severity of injury: AIS A-D.
Intervention: Prospective assessment of patients treated in the intensive care unit (ICU) with aggressive hemodynamic support (including the use of arterial BP catheters, Swan-Ganz pulmonary artery catheters, intravenous fluids, colloid, vasopressors, and surgery for decompression and stabilization) as necessary to maintain mean arterial pressure (MAP) >85 mmHg.
Outcome Measures: Neurological improvement as per AIS classification.
Chronicity: Patients were studied beginning within 36 hrs of injury. Follow-up examinations were performed for each patient at 6, 12, and 18 months post injury.
  1. 60% of patients with complete cervical SCI and 33% of patients with complete thoracic SCI improved at least 1 ASIA grade at the last follow-up examination.
  2. 92% of patients with incomplete cervical SCI and 88% of patients with incomplete thoracic SCI demonstrated improvement in neurological function 1 year post injury.

Levi et al. (1993)

USA
Pre-Post
N=50

Population: Mean age=39.7 yr; Gender: males=88%, females=12%; Level of injury: cervical; Severity of injury: complete (78%), incomplete (22%).
Intervention: Prospective assessment of patients treated in the intensive care unit (ICU) with invasive hemodynamic monitoring and support (including the use of arterial line and Swan-Ganz catheters, fluid replacement, operative stabilization, and dopamine and/or dobutamine) as necessary to maintain mean arterial pressure (MAP) >90 mmHg.
Outcome Measures: Neurological improvement as per modified Frankel classification.
Chronicity: Patients were studied initially within the first week of injury. Follow-up examinations were performed at 6 weeks following injury.
  1. Neurological function was improved by at least one Frankel grade in 20 of 50 (40%) patients.
  2. Neurological function remained the same in 21 of 50 (42%) of patients.
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