Marios Papadopoulos and Samira Saadoun, St George's Hospital, University of London, London, United Kingdom

Effect of fever in patients with acute, severe traumatic spinal cord injury

Funded in: 2019, 2020, 2021


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Problem: The effects of changes in body temperature on the injured cord are unknown

Target: Monitor pressure and metabolism of the injured spinal cord

Goal: Improvements in management with acute, severe spinal cord injuries in the intensive care unit

 

Introduction: In the first few days after a spinal cord injury, many patients develop fever. Common causes of fever include infection (sepsis), e.g. pneumonia, neurogenic fever (caused by damage to spinal cord pathways that control body temperature) and injury to other organs e.g. lung contusions.

Problem statement: The effects of changes in body temperature on the injured cord are unknown.

Methods: In the unit, the researchers insert probes at the injury site to monitor the pressure and metabolism of the injured spinal cord in the intensive care unit. They will determine what happens to spinal cord pressure, metabolism and inflammation during different fevers, i.e. septic fever, neurogenic fever and fever related to organ damage. They will also investigate if a chemical in the blood (serum procalcitonin) can accurately distinguish septic from non-septic fever. Finally, their monitoring technique of pressure and microdialysis from the injury site will be compared with a simpler method, i.e. monitoring from the lumbar cerebrospinal fluid space. The research group will determine whether drainage of lumbar cerebrospinal fluid, which is practiced in some units, improves intraspinal pressure and metabolism at the injury site.

Expected results: It is likely that septic fever is harmful in patients with spinal cord injuries i.e. causes worse spinal cord metabolism, drop in tissue oxygen and increased tissue inflammation at the injury site. It will be interesting to see if non-septic fever is also harmful. They predict that serum procalcitonin can distinguish septic from non-septic fever more accurately than current tests. They do not know whether monitoring from the lumbar cerebrospinal fluid space is accurate or whether drainage of lumbar cerebrospinal fluid reduces intraspinal pressure at the injury site.

Potential application: This project will likely lead to improvements in the management of patients with acute, severe spinal cord injuries in the intensive care unit.