Early Vasopressor Utilization in Critically Ill Patients With Acute Traumatic Spinal Cord Injury: A Retrospective...

Area of Science:

• Neurology
• Critical Care Medicine
• Trauma Surgery

Background:

• Limited evidence exists on vasopressor use in acute spinal cord injury (SCI).
• Early vasopressor administration is common in managing SCI patients.

Purpose of the Study:

• To investigate the association between early vasopressor use and hospital outcomes in acute traumatic SCI.
• To compare the effects of phenylephrine versus norepinephrine on patient outcomes.

Main Methods:

• Retrospective cohort study using the Premier Healthcare Database (2016-2020).
• Included adult patients with acute traumatic SCI (T8 level or above) receiving vasopressors within 48 hours.
• Propensity-score standardized mortality ratio weighting was employed to control for confounding factors.

Main Results:

• Norepinephrine was associated with a higher likelihood of discharge to death/hospice/skilled nursing facility (OR, 1.50) compared to phenylephrine.
• Norepinephrine use correlated with increased adverse events, including urinary tract infections, cardiac arrest, acute kidney injury, and death.
• Patients receiving norepinephrine experienced a longer hospital length of stay (3.68 days longer).

Conclusions:

• Norepinephrine was more frequently used in patients with higher injury severity, suggesting potential indication bias.
• Findings suggest possible differences in efficacy and safety profiles between phenylephrine and norepinephrine in SCI.
• Comparative trials are recommended to definitively assess the comparative effectiveness and safety of these vasopressors in SCI management.