Critical Care Management of Acute Spinal Cord Injury—Part II: Intensive Care to Rehabilitation

J Neuroanaesth Crit Care, 2019 · DOI: 10.1055/s-0039-1694686 · Published: July 1, 2019

Spinal Cord Injury Critical Care Neurorehabilitation

Simple Explanation

Spinal cord injury (SCI) can lead to loss of motor and sensory function, and sometimes cardiovascular or ventilatory failure. Intensive care for SCI patients focuses on managing multiple body systems to reduce further damage to the spinal cord. Early rehabilitation is very important for helping patients recover neurologic and functional abilities.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Not specified

Key Findings

1
Maintaining a MAP of 85 to 90 mm Hg for the first 5 to 7 days after injury may improve clinical outcome.
2
Early tracheostomy (less than 7 days after injury) has a clear benefit in patients who are likely to require prolonged mechanical ventilation.
3
Cervical SCI is highly associated with extracranial carotid and vertebral artery injury.

Research Summary

Comprehensive, interdisciplinary care is essential in the ICU to manage the potentially catastrophic multisystem complications of SCI. Early rehabilitation is crucial for patients who survive the initial hospitalization, promoting continuous care and recovery. Ongoing research focuses on developing molecular agents to aid in neuroprotection and neuroregeneration, aiming to improve long-term outcomes and functional recovery post-injury.

Practical Implications

Hemodynamic Management

Aggressive hemodynamic management, including MAP augmentation, should be carefully considered, balancing potential benefits with the risks of fluid overload and vasopressor administration.

Respiratory Care

Early tracheostomy should be considered for patients with high cervical SCI or those likely to require prolonged ventilation, weighing the benefits of reduced ICU stay and complications against the risks of early intervention.

VTE Prevention

Implement mechanical and chemical thromboprophylaxis early in SCI patients to mitigate the high risk of venous thromboembolism, carefully balancing the benefits against potential bleeding risks.

Study Limitations

1
Lack of prospective controlled data to support MAP augmentation recommendations.
2
Ethical concerns in establishing lower target comparison groups for hemodynamic management.
3
Evolving evidence surrounding screening protocols for BCVI.

Your Feedback

Was this summary helpful?

Back to Spinal Cord Injury