Empirical targets for acute hemodynamic management of individuals with spinal cord injury

Objective: To determine the hemodynamic conditions associated with optimal neurological improvement in acute traumatic spinal cord injury (SCI) individuals who had lumbar intrathecal catheters placed to measure cerebrospinal fluid pressure (CSFP). Methods: Ninety-two acute SCI individuals were enrolled in this multi-center prospective observational clinical trial. We monitored mean arterial pressure (MAP) and CSFP during the first week post-injury, and assessed neurologic function at baseline and six-months post-injury. We used relative risk iterations to determine transition points at which the likelihood of either improving neurologically or remaining unchanged neurologically was equivalent. These transition points guided our analyses where we examined the linear relationships between time spent within target hemodynamic ranges (i.e., clinical adherence) and neurological recovery. Results: Relative risk transition points for CSFP, MAP, and spinal cord perfusion pressure (SCPP) were li...