Duration of intensive care unit admission to maintain mean arterial pressure goals following acute traumatic spinal cord injury.

Abstract

Acute spinal cord injuries (SCIs) remain a devastating consequence of trauma. Treatment may involve administration of neuroprotective agents, surgery, and hemodynamic management. Hemodynamic management entails setting specific mean arterial pressure (MAP) goals to optimize perfusion of the spinal cord. Maintenance of MAP typically requires monitoring in the intensive care unit (ICU) and may necessitate vasopressor medications. This treatment utilizes significant resources. The objective of this study was to determine whether vasopressor requirements during the initial days of ICU admission are predictive of future need for these medications to maintain MAP goals in patients with SCI. A retrospective review of a prospective database was performed to identify all adult patients who presented to a Level 1 academic medical center with SCI between 2016 and 2024. Patients were included if they were between the ages of 18 and 89, had a cervical or thoracic spinal cord injury, and were managed with a MAP goal of at least 85 mmHg for five days. Patients with injury to the conus medullaris or cauda equina were excluded. Data collected included baseline demographics, mechanism of injury, ICU admission details, MAP measurements, and vasopressor use. Fisher's exact test was used to calculate predicted probabilities for subsequent vasopressor administration. A total of 98 patients (median age 62.5 years, range: 18-89 years) were identified. Most patients (90.1%, n = 82) had an SCI involving the cervical spine. The median ICU length of stay was 6 days (range: 1-92 days). Among patients who did not require vasopressors within the first two days of ICU admission (n = 27), 88.9% (n = 24) did not require them subsequently. Furthermore, all patients (n = 24, 24.5%) who did not require vasopressors within the first three days of ICU admission did not need them thereafter. Patients with SCI who did not require vasopressors to maintain a MAP of at least 85 mmHg during the initial two days of ICU stay were unlikely to subsequently need them. This finding can assist providers in improving resource allocation and bed assignment for patients with SCI in the ICU. III.