Pilot study: advanced haemodynamic monitoring after acute spinal cord injury-Keep the pressure up?

• Published in: BMC anesthesiology Vol. 22; no. 1; pp. 1 - 277
• Main Authors: Drotleff, Niklas, Jansen, Oliver, Weckwerth, Christina, Aach, Mirko, Schildhauer, Thomas Armin, Waydhas, Christian, Hamsen, Uwe
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 01.09.2022; BioMed Central; BMC
• Subjects: Advanced haemodynamic monitoring; Analysis; Blood pressure; Cardiovascular system; Catecholamines; Catheters; Coronary artery disease; Heart beat; Heart diseases; Heart failure; Heart rate; Hemodynamics; Infection; Intensive care; MAP goals; Medical research; Medicine, Experimental; Norepinephrine; Patients; Sepsis; Spinal cord injuries; Spinal cord injury; Statistical analysis; Transpulmonary thermodilution; Trauma; Variables; Venous pressure; Ventilators
• ISSN: 1471-2253; 1471-2253
• DOI: 10.1186/s12871-022-01806-2

Abstract Background Although the use of vasopressors to maintain haemodynamic goals after acute spinal cord injury (SCI) is still recommended, evidence regarding the target values and possible risks of this practice is limited, and data on haemodynamic parameters unaffected by catecholamines are rare. In this pilot study, we show the haemodynamic profile of patients with acute SCI mainly unaffected by vasopressor use and other factors that influence the cardiovascular system. Methods From March 2018 to March 2020, we conducted a prospective, single-centre pilot study of 30 patients with acute SCI. Factors that could affect the cardiocirculatory system other than SCI (sepsis, pre-existing heart disease or multiple trauma) led to exclusion. A total of 417 measurements were performed using the PiCCO™ system. Results The mean systemic vascular resistance index (SVRI, 1447.23  ±  324.71 dyn*s*cm −5 *m 2 ), mean central venous pressure (CVP, 10.69  ±  3.16 ) and mean global end-diastolic volume index (GEDVI, 801.79 ± 158.95 ml/m 2 ) deviated from the reference range, while the mean cardiac index (CI), mean stroke volume index (SVI), mean arterial pressure (MAP), and mean heart rate (HR) were within the reference range, as indicated in the literature. A mixed model analysis showed a significant negative relationship between norepinephrine treatment and MAP (83.97 vs. 73.69 mmHg, p  < 0.001), SVRI (1463.40 vs. 1332.14 dyn*s*cm −5 *m 2 , p  = 0.001) and GEDVI (808.89 vs. 759.39 ml/m 2 , p  = 0.001). Conclusion These findings could lead to an adaptation of the target range for SVRI and MAP in patients with acute SCI and therefore reduce the use of vasopressors.