Early Blood Pressure Targets in Acute Spinal Cord Injury: A Randomized Clinical Trial

Area of Science:

• Neurology
• Trauma Care
• Critical Care Medicine

Background:

• Early blood pressure management is crucial for spinal cord injury (SCI) neurologic resuscitation.
• The optimal blood pressure target (augmented vs. conventional) remains unclear.

Purpose of the Study:

• To compare the efficacy and safety of augmented versus conventional blood pressure management on 6-month neurologic outcomes in acute SCI patients.

Main Methods:

• A multicenter randomized clinical trial involving 92 adult SCI patients.
• Patients were randomized to maintain either augmented (>85-90 mm Hg) or conventional (>65-70 mm Hg) mean arterial pressure for 7 days or until ICU discharge.
• Primary endpoints included changes in motor and sensory American Spinal Injury Association Impairment Scale scores at 6 months. Safety endpoints included organ dysfunction and complications.

Main Results:

• No significant differences in motor or sensory score recovery were observed between augmented and conventional blood pressure groups at 6 months.
• The augmented group experienced higher rates of organ dysfunction (modified Sequential Organ Failure Assessment scores), longer mechanical ventilation, and more respiratory complications.
• No differences in mortality or other secondary outcomes were found.

Conclusions:

• This underpowered trial did not demonstrate improved neurologic recovery with early augmented blood pressure in SCI patients.
• The findings question the routine use of augmented blood pressure and suggest potential harm, necessitating further research.
• Future studies should identify patient subgroups who might benefit from augmented blood pressure and elucidate harm mechanisms.