Multi-modal monitoring of patients with severe acute traumatic spinal cord injury
Funded in: 2015, 2016, 2017
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Problem: The early management of spinal cord injury is very variable because there is no monitoring from the injured spinal cord to guide the treating doctors.
Target: Applying a newly developed method to monitor spinal cord pressure in patients with spinal cord injury.
Goal: Improvement of the management of patients with spinal cord injury in the intensive care unit.
Introduction. The early management of spinal cord injury is very variable because there is no monitoring from the injured spinal cord to guide the treating doctors. We recently developed a technique to monitor spinal cord pressure in patients with spinal cord injury. This is similar to monitoring brain pressure, which is essential for managing patients with brain injury.
Problem statement. Aim-1 will develop microdialysis monitoring, which will give hourly information about the metabolism of the injured spinal cord. Aim-2 will look for abnormal electrical activity at the injury site, termed spreading depolarisations. Aim-3 will develop the novel concept of continuous optimum spinal cord perfusion pressure (cSCPPopt).
Methods. We will recruit adult patients with severe spinal cord injury who have surgery within 72 hours. The probes (pressure, microdialysis, electrodes) will be placed on the spinal cord surface at the injury site during surgery. Spinal cord pressure and microdialysis will be monitored in 20 patients. Spinal cord pressure and spreading depolarisations will be monitored in 10 patients. The concept of cSCPPopt will be explored using data from 65 patients.
Expected results. Aim-1. We predict that microdialysis will provide useful information to guide patient management, e.g. when the spinal cord pressure rises, spinal cord metabolism may become abnormal thus alerting the treating doctors to reduce spinal cord pressure. Aim-2. We predict that spreading depolarisations occur after spinal cord injury and are harmful. If this is correct, then preventing spreading depolarisations using drugs will be a novel treatment. Aim-3. We predict that it is possible to calculate cSCPPopt and that cSCPPopt is the target spinal cord perfusion pressure for improving outcome.
Intraoperative visualization of blood flow through injured human spinal cord at two spinal cord perfusion pressures (SCPPs) using ICG fluorescence
Potential application. Our monitoring techniques and novel concept (cSCPPopt) are likely to improve the management of patients with spinal cord injury in the intensive care unit.