Abstract
Study design:
Prospective vasopressor cross-over interventional study
Objectives:
To examine how two vasopressors used in acute traumatic spinal cord injury (SCI) affect intrathecal cerebrospinal fluid pressure and the corresponding spinal cord perfusion pressure (SCPP).
Setting:
Vancouver, British Columbia, Canada.
Methods:
Acute SCI patients over the age of 17 with cervical or thoracic ASIA Impairment Scale (AIS). A, B or C injuries were enrolled in this study. Two vasopressors, norepinephrine and dopamine, were evaluated in a ‘crossover procedure’ to directly compare their effect on the intrathecal pressure (ITP). The vasopressor cross-over procedures were performed in the intensive care unit where ITP, mean arterial pressure (MAP) and heart rate were being continuously measured. The SCPP was calculated as the difference between MAP and ITP.
Results:
A total of 11 patients were enrolled and included in our analysis. There were 6 patients with AIS A, 3 with AIS B and 2 with AIS C injuries at baseline. We performed 24 cross-over interventions in these 11 patients. There was no difference in MAP with the use of norepinephrine versus dopamine (84±1 mm Hg for both; P=0.33). Conversely, ITP was significantly lower with the use of norepinephrine than with dopamine (17±1 mm Hg vs 20±1 mm Hg, respectively, P<0.001). This decrease in ITP with norepinephrine resulted in an increased SCPP during the norepinephrine infusion when compared with dopamine (67±1 mm Hg vs 65±1 mm Hg respectively, P=0.0049).
Conclusion:
Norepinephrine was able to maintain MAP with a lower ITP and a correspondingly higher SCPP as compared with dopamine in this study. These results suggest that norepinephrine may be preferable to dopamine if vasopressor support is required post SCI to maintain elevated MAPs in accordance with published guidelines.
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Acknowledgements
We acknowledge the research staff of the Vancouver Spine Research Program, in particular Allan Aludino, Leilani Reichl, Angela Tsang and Jiwan Gill for their assistance with this study. We also acknowledge support for the conduct of this study from the Michael Smith Foundation for Health Research, the Craig H. Neilsen Foundation and the Rick Hansen Institute (RHI), including Daniel Rogers of RHI for project management. Dr Griesdale is supported by the VGH & UBC Hospital Foundation Best of Health Fund. MFD holds the Paetzold Chair in Spinal Cord Injury Research. FKK holds the Canada Research Chair in Spinal Cord Injury and VGH & UBC Hospital Foundation Dvorak Chair in Spine Trauma.
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Altaf, F., Griesdale, D., Belanger, L. et al. The differential effects of norepinephrine and dopamine on cerebrospinal fluid pressure and spinal cord perfusion pressure after acute human spinal cord injury. Spinal Cord 55, 33–38 (2017). https://doi.org/10.1038/sc.2016.79
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DOI: https://doi.org/10.1038/sc.2016.79
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