TSCI patients with mean SCPP ≈ SCPP opt more often improve their AIS (American spinal injuries association Impairment Scale) grade than patients with SCPP very different from SCPP opt. ISP, SCPP, SCPP opt, and sPRx for TSCI are, respectively, analogous to intracranial pressure (ICP), cerebral perfusion pressure (CPP), optimum CPP (CPP opt), and cerebrovascular pressure reactivity (PRx) for traumatic brain injury (TBI). The U-shaped curve is not always present and may vary throughout the period of monitoring when computed in patients with head injury or spinal cord injury, a U-shaped sPRx versus SCPP relation is present approximately 50% of the time. Thus, the sPRx versus SCPP plot is U-shaped and the optimum SCPP (SCPP opt) is the minimum of the curve. At low SCPP (hypo-perfusion) and high SCPP (hyper-perfusion), autoregulation is impaired (i.e., high sPRx). sPRx ≤ 0 indicates intact vascular pressure reactivity, whereas sPRx > 0 indicates deficient vascular pressure reactivity. sPRx measures the pressure reactivity of the vascular bed, i.e., autoregulation. The technique is safe and allows us to compute the spinal cord perfusion pressure (SCPP) as mean arterial pressure (MAP) minus ISP and the spinal pressure reactivity index (sPRx) as the running correlation coefficient between ISP and MAP. To guide the management of patients with acute, severe TSCI in the intensive care unit, we introduced intraspinal pressure (ISP) monitoring from the injury site. No treatment has been proved to improve outcome, and therefore, patient management remains variable. Traumatic spinal cord injury (TSCI) is a catastrophic condition: Over a third of patients do not recover sensation or voluntary movement below the injury. No factors accurately predict SCPP opt thus, invasive monitoring remains the only way to estimate SCPP opt. Modifiable factors that may lower ISP are: reducing surgical bleeding and performing expansion duroplasty. ConclusionsĮlevated ISP can be predicted by clinical factors. No MRI factors correlated with ISP or SCPP opt. In an ordinal multivariate logistic regression model, these 2 factors predicted SCPP opt as low, medium–low, medium–high, or high with only 42% accuracy. Only 2/28 factors correlated with lower SCPP opt: higher mean ISP and conus medullaris injury. In a multivariate logistic regression model, these 5 factors predicted ISP as normal or high with 73% accuracy. In total 5/28 factors were associated with lower ISP: older age, excess alcohol consumption, nonconus medullaris injury, expansion duroplasty, and less intraoperative bleeding. Thirty-six percentage (22/64) had U-shaped sPRx versus SCPP curves, but the SCPP did not reach the minimum of the curve, and thus, an exact SCPP opt could not be calculated. Thirteen percentage, all AIS grade A or B, had no U-shaped sPRx versus SCPP curves. Fifty-one percentage had U-shaped sPRx versus SCPP curves, thus allowing SCPP opt to be computed. ResultsĪll patients underwent surgery to restore normal spinal alignment within 72 h of injury. We studied how well 28 factors correlate with mean ISP or SCPP opt including 7 patient-related, 3 injury-related, 6 management-related, and 12 preoperative MRI-related factors. For 24 h after surgery, we monitored ISP and SCPP and computed SCPP opt (SCPP that optimizes pressure reactivity). Sixty-four TSCI patients, grades A–C (American spinal injuries association Impairment Scale, AIS), were analyzed. We hypothesized that ISP and SCPP opt can be predicted using clinical factors instead of ISP monitoring. We recently developed techniques to monitor intraspinal pressure (ISP) and spinal cord perfusion pressure (SCPP) from the injury site to compute the optimum SCPP (SCPP opt) in patients with acute traumatic spinal cord injury (TSCI).

Logistic regression xlstat