Data from: 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 linearly associated with neurological improvement and directed the
identification of key hemodynamic target ranges. Clinical adherence to the
target ranges was positively and linearly related to improved neurological
outcomes. Adherence to SCPP targets, not MAP targets, was the best
indicator of improved neurological recovery, which occurred with SCPP
targets of 60-65 mmHg. Failing to maintain the SCPP within the target
ranges was an important detrimental factor in neurologic recovery,
particularly if the target range is set lower. Conclusion: We provide an
empirical, data-driven approach to aid institutions in setting hemodynamic
management targets that accept the real-life challenges of adherence to
specific targets. Our results provide a framework to guide the development
of widespread institutional management guidelines for acute traumatic SCI.