Comparing Continuous versus Intermittent-Threshold Drainage Strategies for Spinal Perfusion Pressure Optimization in Patients with Acute Traumatic Spinal Cord Injuries Article Swipe
Raj Swaroop Lavadi
,
Regan M. Shanahan
,
D. Kojo Hamilton
,
Thomas J. Buell
,
Nitin Agarwal
,
Ava M. Puccio
,
David O. Okonkwo
,
Daryl P. Fields
·
YOU?
·
· 2023
· Open Access
·
· DOI: https://doi.org/10.1101/2023.08.18.23291810
YOU?
·
· 2023
· Open Access
·
· DOI: https://doi.org/10.1101/2023.08.18.23291810
Study Design A cross-sectional study. Objective The primary objective of this study is to compare the efficacy of continuous versus threshold drainage strategies for maintaining spinal cord perfusion pressure (SCPP) in patients with new traumatic spinal cord injuries (SCI). Setting Level 1 trauma center. Methods A retrospective study of 19 patients with traumatic SCIs. SCPP was optimized at the discretion of the managing clinician using either vasopressors to increase mean arterial pressure or cerebral spinal fluid (CSF) drainage to decrease intrathecal pressure. Six patients were managed with continuous drainage (CSF drained at regular intervals regardless of SCPP) and 13 had CSF drained only when SCPP fell below 65mmHg (i.e. threshold drainage). Intrathecal pressure, SCPP, mean arterial pressure, and vasopressor utilization were compared using univariate T-test statistical analysis. Results The cohort included over 1500 time points from 19 patients. While there was no difference in rates of sub-optimal SCPP (< 65mmHg; p = 0.257), patients managed with threshold drainage were more likely to exhibit critically-low SCPP (< 50 mmHg; p = 0.003) despite also having lower average intrathecal pressures (p < 0.001). There were no differences in average SCPP, MAP, or vasopressor utilization between the two groups (p > 0.05). Conclusions Acute SCI patients managed with continuous CSF drainage were less likely to exhibit critically-low SCPPs, previously shown to be associated with worse clinical recovery. A larger, prospective cohort is needed to validate the impact of CSF drainage strategies on long-term SCI outcomes.
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Metadata
- Type
- preprint
- Language
- en
- Landing Page
- https://doi.org/10.1101/2023.08.18.23291810
- https://www.medrxiv.org/content/medrxiv/early/2023/08/20/2023.08.18.23291810.full.pdf
- OA Status
- green
- References
- 11
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4386029211
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W4386029211Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1101/2023.08.18.23291810Digital Object Identifier
- Title
-
Comparing Continuous versus Intermittent-Threshold Drainage Strategies for Spinal Perfusion Pressure Optimization in Patients with Acute Traumatic Spinal Cord InjuriesWork title
- Type
-
preprintOpenAlex work type
- Language
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enPrimary language
- Publication year
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2023Year of publication
- Publication date
-
2023-08-20Full publication date if available
- Authors
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Raj Swaroop Lavadi, Regan M. Shanahan, D. Kojo Hamilton, Thomas J. Buell, Nitin Agarwal, Ava M. Puccio, David O. Okonkwo, Daryl P. FieldsList of authors in order
- Landing page
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https://doi.org/10.1101/2023.08.18.23291810Publisher landing page
- PDF URL
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https://www.medrxiv.org/content/medrxiv/early/2023/08/20/2023.08.18.23291810.full.pdfDirect link to full text PDF
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YesWhether a free full text is available
- OA status
-
greenOpen access status per OpenAlex
- OA URL
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https://www.medrxiv.org/content/medrxiv/early/2023/08/20/2023.08.18.23291810.full.pdfDirect OA link when available
- Concepts
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Medicine, Anesthesia, Spinal cord, Drainage, Perfusion, Mean arterial pressure, Cerebral perfusion pressure, Surgery, Blood pressure, Internal medicine, Heart rate, Psychiatry, Ecology, BiologyTop concepts (fields/topics) attached by OpenAlex
- Cited by
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0Total citation count in OpenAlex
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11Number of works referenced by this work
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10Other works algorithmically related by OpenAlex
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