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Continuous monitoring and visualization of optimum spinal cord perfusion pressure in patients with acute cord injury.

Chen, S; Smieleweski, P; Czosnyka, M; Papadopoulos, MC; Saadoun, S (2017) Continuous monitoring and visualization of optimum spinal cord perfusion pressure in patients with acute cord injury. J Neurotrauma, 34 (21). pp. 2941-2949. ISSN 1557-9042 https://doi.org/10.1089/neu.2017.4982
SGUL Authors: Papadopoulos, Marios Saadoun, Samira Chen, Su Liang

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Abstract

The optimum spinal cord perfusion pressure (SCPP) after traumatic spinal cord injury (TSCI) is unknown. Here, we describe techniques to compute and display the optimum SCPP in real-time. We recruited adults within 72 hours of severe TSCI (ASIA grades A-C). A pressure probe and a microdialysis catheter were placed on the injured cord. SCPP was computed as mean arterial pressure (MAP) minus intraspinal pressure (ISP), spinal pressure reactivity index (sPRx) as the running ISP/MAP correlation coefficient and continuous optimum SCPP (cSCPPopt) as the SCPP that minimizes sPRx in a moving four-hour window. In 45 patients, we monitored ISP and blood pressure. In 14 patients, we also monitored injury site metabolism. cSCPPopt could be computed 45 % of the time. Mean cSCPPopt varied by up to 60 mmHg between patients and each patient's cSCPPopt varied with time (standard deviation 10-20 mmHg). Color-coded maps showing the sPRx/SCPP curve evolution enhanced visualization of cSCPPopt. Periods when SCPP ≈ cSCPPopt were associated with low injury site glucose, high pyruvate and high lactate. Mean SCPP deviation from cSCPPopt inversely correlated with neurological outcome at 9-12 months: ASIA grade improved in 30 % patients with <5 mmHg deviation, 10 % with 5-15 mmHg deviation and no-one with >15 mmHg deviation. We conclude that real-time computation and visualization of cSCPPopt after TSCI are feasible. cSCPPopt appears to enhance glucose utilization at the injury site and varies widely between and within patients. Our data suggest that targeting cSCPPopt after TSCI might improve neurological outcome.

Item Type: Article
Additional Information: Final publication is available from Mary Ann Liebert, Inc., publishers http://dx.doi.org/10.1089/neu.2017.4982
Keywords: METABOLISM, MICRODIALYSIS, spinal cord injury, Neurology & Neurosurgery, 1103 Clinical Sciences, 1109 Neurosciences
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) > Neuroscience (INCCNS)
Journal or Publication Title: J Neurotrauma
ISSN: 1557-9042
Language: eng
Dates:
DateEvent
November 2017Published
29 March 2017Published Online
18 January 2017Accepted
Publisher License: Publisher's own licence
PubMed ID: 28351230
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/108776
Publisher's version: https://doi.org/10.1089/neu.2017.4982

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