Best way to handle pressure


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To provide optimal conditions on an intensive care unit for patients with acute spinal cord injury is a very important goal for recovery. In that vulnerable phase, medical teams do their best that patients can regain function, do not suffer from complications or secondary spinal damage.
To be more precise, medical doctors want to achieve a preservation of the best metabolic situation, an optimized oxygenation and tissue pressure in the spinal cord.
As of now more mechanistical insights especially regarding pressure management from basic and clinical research are needed to understand how to establish the best physiological conditions.
Therefore, a group of two scientific leaders on that clinical field, neurosurgeon Papadopoulos and neuroscientist Saadoun from St George's Hospital, London, investigated how medically induced increased spinal cord perfusion pressure influences nerve conduction, neuronal metabolism and clinical outcome.Their key question was, if optimizing the arterial blood pressure might be beneficial for maximizing recovery.

Is higher pressure beneficial?
The spinal cord is a narrow tunnel. Normally this offers protection but can cause problems in case of injury. Imagine yourself trapped in an elevator with an expanding balloon. At some point, the balloon will squeeze and hurt you. Basically, the same happens in a spinal cord injury. The spinal tissue expands and gets squeezed against the bones surrounding it, further damaging it. Increasing spinal cord perfusion pressure should diminish the squeezing and therefore limit the damage.
In a current study the team from London found that this is the case in only half of the patients. For the others an increased damage was detected. In conclusion only monitoring and treating blood pressure is not reflecting the whole pathophysiological situation and other factors should be considered individually and adapted to different timepoints and to different clinical conditions.

Tailored treatment
As the optimal pressure is different for each patient and will even vary over time, the best result is reached by tailoring the optimal perfusion pressure to each case. Individualized management should be preferred over application of universal blood pressure. In their future work the group is aiming on individualized targets and a more specific monitoring and management in acute spinal cord injury.


This study was published in the “Journal of Critical Care” and was supported by Wings for Life.

 

Source:“Heterogeneous effect of increasing spinal cord perfusion pressure on sensory evoked potentials recorded from acutely injured human spinal cord” by Gallagher MJ, López DM, Sheen HV, Hogg FRA, Zoumprouli A, Papadopoulos MC and Saadoun S. Published in theJournal of Critical Care.