Pilot study: advanced haemodynamic monitoring after acute spinal cord injury-Keep the pressure up?
Abstract Background Although the use of vasopressors to maintain haemodynamic goals after acute spinal cord injury (SCI) is still recommended, evidence regarding the target values and possible risks of this practice is limited, and data on haemodynamic parameters unaffected by catecholamines are rar...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-09-01
|
| Series: | BMC Anesthesiology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12871-022-01806-2 |
| _version_ | 1817994049977581568 |
|---|---|
| author | Niklas Drotleff Oliver Jansen Christina Weckwerth Mirko Aach Thomas Armin Schildhauer Christian Waydhas Uwe Hamsen |
| author_facet | Niklas Drotleff Oliver Jansen Christina Weckwerth Mirko Aach Thomas Armin Schildhauer Christian Waydhas Uwe Hamsen |
| author_sort | Niklas Drotleff |
| collection | DOAJ |
| description | Abstract Background Although the use of vasopressors to maintain haemodynamic goals after acute spinal cord injury (SCI) is still recommended, evidence regarding the target values and possible risks of this practice is limited, and data on haemodynamic parameters unaffected by catecholamines are rare. In this pilot study, we show the haemodynamic profile of patients with acute SCI mainly unaffected by vasopressor use and other factors that influence the cardiovascular system. Methods From March 2018 to March 2020, we conducted a prospective, single-centre pilot study of 30 patients with acute SCI. Factors that could affect the cardiocirculatory system other than SCI (sepsis, pre-existing heart disease or multiple trauma) led to exclusion. A total of 417 measurements were performed using the PiCCO™ system. Results The mean systemic vascular resistance index (SVRI, 1447.23 ± 324.71 dyn*s*cm −5 *m 2 ), mean central venous pressure (CVP, 10.69 ± 3.16) and mean global end-diastolic volume index (GEDVI, 801.79 ± 158.95 ml/m2) deviated from the reference range, while the mean cardiac index (CI), mean stroke volume index (SVI), mean arterial pressure (MAP), and mean heart rate (HR) were within the reference range, as indicated in the literature. A mixed model analysis showed a significant negative relationship between norepinephrine treatment and MAP (83.97 vs. 73.69 mmHg, p < 0.001), SVRI (1463.40 vs. 1332.14 dyn*s*cm−5*m2, p = 0.001) and GEDVI (808.89 vs. 759.39 ml/m2, p = 0.001). Conclusion These findings could lead to an adaptation of the target range for SVRI and MAP in patients with acute SCI and therefore reduce the use of vasopressors. |
| first_indexed | 2024-04-14T01:47:41Z |
| format | Article |
| id | doaj.art-625c386dc7894bc6b407972c8cf1024e |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-04-14T01:47:41Z |
| publishDate | 2022-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-625c386dc7894bc6b407972c8cf1024e2022-12-22T02:19:28ZengBMCBMC Anesthesiology1471-22532022-09-012211710.1186/s12871-022-01806-2Pilot study: advanced haemodynamic monitoring after acute spinal cord injury-Keep the pressure up?Niklas Drotleff0Oliver Jansen1Christina Weckwerth2Mirko Aach3Thomas Armin Schildhauer4Christian Waydhas5Uwe Hamsen6Department of General and Trauma Surgery, BG University Hospital BergmannsheilDepartment of General and Trauma Surgery, BG University Hospital BergmannsheilFaculty of PsychologyDepartment of Spinal Cord Injury, BG University Hospital BergmannsheilDepartment of General and Trauma Surgery, BG University Hospital BergmannsheilDepartment of General and Trauma Surgery, BG University Hospital BergmannsheilDepartment of General and Trauma Surgery, BG University Hospital BergmannsheilAbstract Background Although the use of vasopressors to maintain haemodynamic goals after acute spinal cord injury (SCI) is still recommended, evidence regarding the target values and possible risks of this practice is limited, and data on haemodynamic parameters unaffected by catecholamines are rare. In this pilot study, we show the haemodynamic profile of patients with acute SCI mainly unaffected by vasopressor use and other factors that influence the cardiovascular system. Methods From March 2018 to March 2020, we conducted a prospective, single-centre pilot study of 30 patients with acute SCI. Factors that could affect the cardiocirculatory system other than SCI (sepsis, pre-existing heart disease or multiple trauma) led to exclusion. A total of 417 measurements were performed using the PiCCO™ system. Results The mean systemic vascular resistance index (SVRI, 1447.23 ± 324.71 dyn*s*cm −5 *m 2 ), mean central venous pressure (CVP, 10.69 ± 3.16) and mean global end-diastolic volume index (GEDVI, 801.79 ± 158.95 ml/m2) deviated from the reference range, while the mean cardiac index (CI), mean stroke volume index (SVI), mean arterial pressure (MAP), and mean heart rate (HR) were within the reference range, as indicated in the literature. A mixed model analysis showed a significant negative relationship between norepinephrine treatment and MAP (83.97 vs. 73.69 mmHg, p < 0.001), SVRI (1463.40 vs. 1332.14 dyn*s*cm−5*m2, p = 0.001) and GEDVI (808.89 vs. 759.39 ml/m2, p = 0.001). Conclusion These findings could lead to an adaptation of the target range for SVRI and MAP in patients with acute SCI and therefore reduce the use of vasopressors.https://doi.org/10.1186/s12871-022-01806-2Spinal cord injuryAdvanced haemodynamic monitoringTranspulmonary thermodilutionMAP goals |
| spellingShingle | Niklas Drotleff Oliver Jansen Christina Weckwerth Mirko Aach Thomas Armin Schildhauer Christian Waydhas Uwe Hamsen Pilot study: advanced haemodynamic monitoring after acute spinal cord injury-Keep the pressure up? BMC Anesthesiology Spinal cord injury Advanced haemodynamic monitoring Transpulmonary thermodilution MAP goals |
| title | Pilot study: advanced haemodynamic monitoring after acute spinal cord injury-Keep the pressure up? |
| title_full | Pilot study: advanced haemodynamic monitoring after acute spinal cord injury-Keep the pressure up? |
| title_fullStr | Pilot study: advanced haemodynamic monitoring after acute spinal cord injury-Keep the pressure up? |
| title_full_unstemmed | Pilot study: advanced haemodynamic monitoring after acute spinal cord injury-Keep the pressure up? |
| title_short | Pilot study: advanced haemodynamic monitoring after acute spinal cord injury-Keep the pressure up? |
| title_sort | pilot study advanced haemodynamic monitoring after acute spinal cord injury keep the pressure up |
| topic | Spinal cord injury Advanced haemodynamic monitoring Transpulmonary thermodilution MAP goals |
| url | https://doi.org/10.1186/s12871-022-01806-2 |
| work_keys_str_mv | AT niklasdrotleff pilotstudyadvancedhaemodynamicmonitoringafteracutespinalcordinjurykeepthepressureup AT oliverjansen pilotstudyadvancedhaemodynamicmonitoringafteracutespinalcordinjurykeepthepressureup AT christinaweckwerth pilotstudyadvancedhaemodynamicmonitoringafteracutespinalcordinjurykeepthepressureup AT mirkoaach pilotstudyadvancedhaemodynamicmonitoringafteracutespinalcordinjurykeepthepressureup AT thomasarminschildhauer pilotstudyadvancedhaemodynamicmonitoringafteracutespinalcordinjurykeepthepressureup AT christianwaydhas pilotstudyadvancedhaemodynamicmonitoringafteracutespinalcordinjurykeepthepressureup AT uwehamsen pilotstudyadvancedhaemodynamicmonitoringafteracutespinalcordinjurykeepthepressureup |