1. Optimization of the mean arterial pressure and timing of surgical decompression in traumatic spinal cord injury: a retrospective study.
- Author
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Dakson A, Brandman D, Thibault-Halman G, and Christie SD
- Subjects
- Acute Disease, Adolescent, Adult, Aged, Aged, 80 and over, Female, Follow-Up Studies, Humans, Male, Middle Aged, Recovery of Function, Retrospective Studies, Severity of Illness Index, Time-to-Treatment, Treatment Outcome, Young Adult, Arterial Pressure physiology, Decompression, Surgical, Spinal Cord Injuries physiopathology, Spinal Cord Injuries surgery
- Abstract
Study Design: A retrospective comparative study., Objectives: This study aims to investigate the extent to which early surgical decompression and maintenance of MAP ⩾85 mm Hg for 5 days postinjury affected neurological recovery utilizing internal controls for comparison of outcomes in patients with traumatic spinal cord injury., Setting: Acute trauma center, Halifax, Nova Scotia, Canada., Methods: We identified 94 cases of traumatic SCI. Follow-up data were available at an average of 26.7±19.5, 115.0±69.3, and 252.0±152.8 days postinjury for 61, 48, and 47 patients, respectively. Neurological recovery was assessed using the American Spinal Cord Injury Association (ASIA) Impairment Scale (AIS)., Results: Patients with MAP <85 mm Hg for at least 2 consecutive hours during the 5-day period postinjury were 11 times less likely to have an improvement in the AIS grade when compared with patients with MAP ⩾85 mm Hg (P=0.006). This association was independent of early surgery or the severity of SCI. At a mean of 252.0 days postinjury, a significantly greater proportion of SCI patients treated with early surgical decompression (within 24 h) improved neurologically (P=0.031)., Conclusions: Our data demonstrated that there may be improved neurologic outcomes in patients with SCI who undergo early surgical decompression. Maintenance of MAP ⩾85 mm Hg for 5 consecutive days post-SCI was also associated with higher rates of AIS grade improvement at mean 26.7 days without a statistically significance difference at prolonged follow-up although a higher rate of neurological recovery persisted in patients with MAP ⩾85 mm Hg.
- Published
- 2017
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