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 h of severe TSCI (American Spinal Injuries Association [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 4-h 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 mm Hg between patients. Each patient's cSCPPopt varied with time (standard deviation 10-20 mm Hg). 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 correlated with worse neurological outcome at 9-12 months: ASIA grade improved in 30% of patients with <5 mm Hg deviation, 10% of patients with 5-15 mm Hg deviation, and no one with >15 mm Hg 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.
journal_name
J Neurotraumajournal_title
Journal of neurotraumaauthors
Chen S,Smielewski P,Czosnyka M,Papadopoulos MC,Saadoun Sdoi
10.1089/neu.2017.4982subject
Has Abstractpub_date
2017-11-01 00:00:00pages
2941-2949issue
21eissn
0897-7151issn
1557-9042journal_volume
34pub_type
临床试验,杂志文章abstract::Following a controlled, severe contusion lesion to the lower thoracic spinal cord in adult rats, we found that apoptosis occurred in cells located in both gray and white matter. This suggested that both nonneuronal cells, including astrocytes, oligodendroglia and microglia, as well as neurons, might participate in pro...
journal_title:Journal of neurotrauma
pub_type: 杂志文章
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journal_title:Journal of neurotrauma
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journal_title:Journal of neurotrauma
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journal_title:Journal of neurotrauma
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doi:10.1089/neu.1995.12.257
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journal_title:Journal of neurotrauma
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doi:10.1089/089771502762300256
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journal_title:Journal of neurotrauma
pub_type: 杂志文章
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journal_title:Journal of neurotrauma
pub_type: 杂志文章,评审
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更新日期:2016-01-01 00:00:00
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journal_title:Journal of neurotrauma
pub_type: 杂志文章,评审
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journal_title:Journal of neurotrauma
pub_type: 杂志文章,随机对照试验
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更新日期:2018-11-15 00:00:00
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journal_title:Journal of neurotrauma
pub_type: 杂志文章
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更新日期:1992-10-01 00:00:00
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journal_title:Journal of neurotrauma
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更新日期:2017-02-01 00:00:00
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journal_title:Journal of neurotrauma
pub_type: 杂志文章
doi:10.1089/neu.2012.2728
更新日期:2013-06-15 00:00:00
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更新日期:2018-09-15 00:00:00
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journal_title:Journal of neurotrauma
pub_type: 杂志文章
doi:10.1089/neu.2014.3539
更新日期:2015-07-15 00:00:00
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journal_title:Journal of neurotrauma
pub_type: 杂志文章
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更新日期:2000-02-01 00:00:00
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journal_title:Journal of neurotrauma
pub_type: 杂志文章,随机对照试验
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pub_type: 杂志文章
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journal_title:Journal of neurotrauma
pub_type: 杂志文章
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更新日期:2018-08-01 00:00:00
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journal_title:Journal of neurotrauma
pub_type: 杂志文章
doi:10.1089/neu.2020.7151
更新日期:2021-01-11 00:00:00
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journal_title:Journal of neurotrauma
pub_type: 杂志文章
doi:10.1089/neu.2011.1976
更新日期:2012-02-10 00:00:00
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journal_title:Journal of neurotrauma
pub_type: 杂志文章
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更新日期:2017-02-15 00:00:00
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journal_title:Journal of neurotrauma
pub_type: 杂志文章
doi:10.1089/089771501750055776
更新日期:2001-01-01 00:00:00
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journal_title:Journal of neurotrauma
pub_type: 杂志文章
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更新日期:2012-04-10 00:00:00
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journal_title:Journal of neurotrauma
pub_type: 杂志文章
doi:10.1089/neu.1996.13.325
更新日期:1996-06-01 00:00:00
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journal_title:Journal of neurotrauma
pub_type: 杂志文章
doi:10.1089/neu.1990.7.247
更新日期:1990-01-01 00:00:00