Current practices and goals for mean arterial pressure and spinal cord perfusion pressure in acute traumatic spinal cord injury: Defining the gaps in knowledge

The primary treatment for acute traumatic spinal cord injury (SCI) involves artificially increasing the patient's mean arterial pressure (MAP) to over 85 mmHg for 7 days to enhance blood flow to the injured spinal cord. However, the guidelines for surgical management of acute SCI are based only on Level III evidence, largely extrapolated from traumatic brain injury (TBI) literature. There is a lack of consensus on which vasopressor should be used to achieve MAP goals, with trauma centers favoring phenylephrine (PE) or norepinephrine (NE), while others use dopamine (DA).

• 1
  Norepinephrine (NE) may be the vasopressor of choice in acute traumatic SCI, potentially offering benefits over phenylephrine (PE) and dopamine (DA).
• 2
  Spinal parenchymal pressure monitors can be safely placed at the injury site, providing direct measurements of spinal cord perfusion pressure (SCPP).
• 3
  The combination of MAP elevation and cerebrospinal fluid drainage (CSFD) may improve neurologic outcome more than either intervention alone.