Blood pressure management in acute spinal cord injury: A retrospective study of acute intensive care management of traumatic spinal cord injury in two New South Wales referral centres

Tessa Garside; Ralph Stanford; Oliver Flower; Trent Li; Edward Dababneh; Naomi Hammond; Frances Bass; James Middleton; Jonathan Tang; Jonathan Ball; Anthony Delaney

doi:10.1016/j.aucc.2024.09.016

Blood pressure management in acute spinal cord injury: A retrospective study of acute intensive care management of traumatic spinal cord injury in two New South Wales referral centres

Aust Crit Care. 2024 Nov 15:101131. doi: 10.1016/j.aucc.2024.09.016. Online ahead of print.

Authors

Affiliations

¹ Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Australia; The George Institute for Global Health, Australia; University of Sydney, Australia. Electronic address: [email protected].
² Department of Orthopaedic Surgery, Prince of Wales Hospital, Australia; Neuroscience Research Australia, Prince of Wales Hospital, Australia.
³ Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Australia.
⁴ Department of Orthopaedic Surgery, Prince of Wales Hospital, Australia.
⁵ Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Australia; The George Institute for Global Health, Australia.
⁶ Department of Spinal Rehabilitation, Royal Rehab Hospital, Australia.
⁷ Department of Neurosurgery, Royal North Shore Hospital, Australia.
⁸ Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Australia; The George Institute for Global Health, Australia; University of Sydney, Australia.

PMID: 39550336
DOI: 10.1016/j.aucc.2024.09.016

Abstract

Background: International guidelines recommend maintenance of mean arterial pressure (MAP) > 85 mmHg to defend spinal cord perfusion pressure after acute traumatic spinal cord injury (SCI). Variation in practice has been demonstrated in the emergency department blood pressure management of SCI in New South Wales (NSW). It is unknown whether this variation exists in the phase of intensive care management of acute SCI.

Objectives: The objective of this study was to describe and compare current blood pressure management in the intensive care unit (ICU) of patients with acute traumatic SCI in two SCI referral centres in NSW.

Methods: Patients with acute traumatic SCI admitted to two SCI referral centres, Unit A and Unit B during 2018-2019 in NSW, were included. Data were summarised using descriptive statistics.

Results: Ninety-eight patients were included, with 91 patients having been prescribed a blood pressure target, 81 (83%) having required vasopressors, and 18 (18%) of these having been documented to have complications associated with vasopressor use. The average prescribed MAP target was 78 (interquartile range [IQR]: 10) mmHg in Unit A and 76 (IQR: 12) mmHg in Unit B. Median durations of prescribed target were 120 (IQR: 72) hours and 120 (IQR: 120) hours in Unit A and Unit B, respectively. The average MAP over the first 7 d was 88 (standard deviation: 9.5) mmHg in Unit A and 85 (standard deviation: 7.5) mmHg in Unit B. Sixty-three patients (64%) had a documented systolic blood pressure <90 mmHg in the first 24 h. Median ICU length of stay (LOS) was 9.7 (IQR: 11) d in Unit A and 6 (IQR: 6.6) d in Unit B. Median hospital LOS was 27 (IQR: 56.2) d in Unit B and 34.7 (IQR: 32.3) d in Unit B. ICU LOS was longer in patients who had a MAP target than in those who did not.

Conclusions: Current blood pressure management in acute SCI in NSW involves ICU admission and blood pressure support with vasopressors; however, prescribed blood pressure targets are not in line with international guidelines.

Keywords: Arterial pressure; Blood pressure; Critical care; Emergency service; Humans; Intensive care units; Length of stay; Referral and consultation; Spinal cord injuries.