A systematic review of intensive cardiopulmonary management after spinal cord injury

Intensive cardiopulmonary management is frequently undertaken in patients with spinal cord injury (SCI), particularly due to the occurrence of neurogenic shock and ventilatory insufficiency and in an attempt to reduce secondary injury. We undertook a systematic review of the literature to examine the evidence that intensive care management improves outcome after SCI and to attempt to define key parameters for cardiopulmonary support/resuscitation. We review the literature in five areas: management of SCI patients in specialized centers, risk in SCI patients of cardiopulmonary complications, parameters for blood pressure and oxygenation/ventilation support following SCI, risk factors for cardiopulmonary insufficiency requiring ICU care after SCI, and preventative strategies to reduce the risks of cardiopulmonary complications in SCI patients. The literature supports that, in light of the significant incidence of cardiorespiratory complications, SCI patients should be managed in a monitored special care unit. There is weak evidence supporting the maintenance of MAP >85 mmHg for a period extending up to 1 week following SCI.