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Heterogeneous effect of increasing spinal cord perfusion pressure on sensory evoked potentials recorded from acutely injured human spinal cord.
- Source :
-
Journal of critical care [J Crit Care] 2020 Apr; Vol. 56, pp. 145-151. Date of Electronic Publication: 2019 Dec 23. - Publication Year :
- 2020
-
Abstract
- Purpose: To investigate the effect of increasing spinal cord perfusion pressure (SCPP) on sensory evoked potentials (SEPs) and injury site metabolism in patients with severe traumatic spinal cord injury TSCI.<br />Materials and Methods: In 12 TSCI patients we placed a pressure probe, a microdialysis catheter and a strip electrode with 8 contacts on the surface of the injured cord. We monitored SCPP, lactate-to-pyruvate ratio (LPR) and SEPs (after median or posterior tibial nerve stimulation).<br />Results: Increase in SCPP by ~20 mmHg produced a heterogeneous response in SEPs and injury site metabolism. In some patients, SEP amplitudes increased and the LPR decreased indicating improved tissue metab olism. In others, SEP amplitudes decreased and the LPR increased indicating more impaired metabolism. Compared with patients who did not improve at follow-up, those who improved had significantly more electrode contacts with SEP amplitude increase in response to increasing SCPP.<br />Conclusions: Increasing SCPP after acute, severe TSCI may be beneficial (if associated with increase in SEP amplitude) or detrimental (if associated with decrease in SEP amplitude). Our findings support individualized management of patients with acute, severe TSCI guided by monitoring from the injury site rather than applying universal blood pressure targets as is current clinical practice.<br />Competing Interests: Declaration of Competing Interest There are no conflicts of interest.<br /> (Copyright © 2019 Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
Blood Pressure
Catheterization
Electric Stimulation Therapy
Electrophysiology
Female
Humans
Lactic Acid blood
Magnetic Resonance Imaging
Male
Microdialysis
Middle Aged
Monitoring, Physiologic
Perfusion
Pressure
Pyruvic Acid blood
Tibial Nerve
Tomography, X-Ray Computed
Young Adult
Cerebrospinal Fluid Pressure
Evoked Potentials, Somatosensory
Spinal Cord physiopathology
Spinal Cord Injuries diagnosis
Spinal Cord Injuries physiopathology
Subjects
Details
- Language :
- English
- ISSN :
- 1557-8615
- Volume :
- 56
- Database :
- MEDLINE
- Journal :
- Journal of critical care
- Publication Type :
- Academic Journal
- Accession number :
- 31901650
- Full Text :
- https://doi.org/10.1016/j.jcrc.2019.12.019