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Blood pressure and spinal cord injury

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https://www.readbyqxmd.com/read/28816870/spinal-cord-injury-what-are-the-controversies
#1
Christopher S Ahuja, Gregory D Schroeder, Alexander R Vaccaro, Michael G Fehlings
Traumatic spinal cord injuries have a tremendous impact on individuals, families, and society as a whole. Substantial heterogeneity in the patient population, their presentation and underlying pathophysiology has sparked debates along the care spectrum from initial assessment to definitive treatment. This article reviews spinal cord injury (SCI) management followed by a discussion of the salient controversies in the field. Current care practices modeled on the American Association of Neurological Surgeons/Congress of Neurological Surgeons joint section guidelines are highlighted including key recommendations regarding immobilization, avoidance of hypotension, early International Standards for Neurological Classification of SCI examination and intensive care unit treatment...
September 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28814247/fluid-and-medication-considerations-in-the-traumatized-patient
#2
Amita Misir
This article reviews fluid therapy and medications in pediatric trauma. For resuscitation in the setting of hemorrhagic shock, isotonic crystalloid solution is the first-line agent of choice. Colloid solutions offer no additional benefit, introduce possible increased risks and cost more than crystalloids. Blood products, starting with pRBCs, should be introduced after 20-40 ml/kg of crystalloid has been administered if there is ongoing need for volume replacement. The use of a massive transfusion protocol of 1:1:1 (if >30 kg) or 30:20:20 (if <30 kg) of pRBCs:FFP:platelets is suggested after an initial 30 ml/kg of pRBcs have been administered...
August 14, 2017: Current Pediatric Reviews
https://www.readbyqxmd.com/read/28802811/effects-of-respiratory-training-on-heart-rate-variability-and-baroreflex-sensitivity-in-individuals-with-chronic-spinal-cord-injury
#3
Bonnie E Legg Ditterline, Sevda C Aslan, David C Randall, Susan J Harkema, Camilo Castillo, Alexander V Ovechkin
OBJECTIVE: To evaluate the effects of pressure threshold respiratory training (RT) on heart rate variability and baroreflex sensitivity in persons with chronic spinal cord injury (SCI). DESIGN: Before-after intervention case-controlled clinical study. SETTING: SCI research center and outpatient rehabilitation unit. PARTICIPANTS: Persons with chronic SCI ranging from C2 to T11 that participated in RT (n=24) and untrained chronic SCI controls ranging from C2 to T9 (n=20)...
August 9, 2017: Archives of Physical Medicine and Rehabilitation
https://www.readbyqxmd.com/read/28776131/pure-distraction-injury-of-t1-2-with-quad-fever
#4
Jun-Yeong Seo, Chae-Moon Lim, Young-Hoon Kim, Kee-Yong Ha
INTRODUCTION: We report a pure distraction injury of the upper thoracic spine and uncontrolled hyperthermia without an infectious cause. Quad fever appears in the first several weeks to months after a cervical or upper thoracic SCI and is characterized by an extreme elevation in body core temperature beyond 40 °C without an infectious cause. Discriminating between infectious and noninfectious causes is important, and a thorough clinical assessment is required. MATERIALS AND METHODS: A 52-year-old male visited the emergency room complaining of back pain with complete paralysis [American Spinal Injury Association (ASIA) A] of both lower extremities after a pedestrian-motor vehicle accident...
August 3, 2017: European Spine Journal
https://www.readbyqxmd.com/read/28758566/the-influence-of-level-of-spinal-cord-injury-on-adipose-tissue-and-its-relationship-to-inflammatory-adipokines-and-cardiometabolic-profiles
#5
Gary J Farkas, Ashraf S Gorgey, David R Dolbow, Arthur S Berg, David R Gater
OBJECTIVE: Level of injury (LOI) and the role of adipose tissue and its proinflammatory adipokines in cardiometabolic dysfunction following spinal cord injury (SCI) remains poorly understood. We aim to examine the influence of LOI on adipose tissue and its relationship to proinflammatory adipokines and cardiometabolic profiles following SCI. DESIGN: Cross sectional and correlational study. SETTING: Clinical hospital and academic setting. PARTICIPANTS: Forty-seven individuals with chronic motor complete SCI (age 43...
July 30, 2017: Journal of Spinal Cord Medicine
https://www.readbyqxmd.com/read/28742157/angiotensin-ii-system-in-the-nucleus-tractus-solitarii-contributes-to-autonomic-dysreflexia-in-rats-with-spinal-cord-injury
#6
Kai Wang, Shaoxia Duan, Xueping Wen, Weizhong Wang, Shangping Fang, Dunyi Qi, Xiang Huan, Liwei Wang, Zhenzhou He
BACKGROUND: Autonomic dysreflexia (AD) is a potentially life-threating complication after spinal cord injury (SCI), characterized by episodic hypertension induced by colon or bladder distension. The objective of this study was to determine the role of impaired baroreflex regulation by the nucleus tractus solitarii(NTS) in the occurrence of AD in a rat model. METHODS: T4 spinal cord transection animal model was used in this study, which included 40 Male rats Colorectal distension (CD) was performed to assess AD and compare the changes of BP, HR, and BRS, six weeks after operation...
2017: PloS One
https://www.readbyqxmd.com/read/28728939/autonomic-dysreflexia-somatosympathetic-and-viscerosympathetic-vasoconstrictor-responses-to-innocuous-and-noxious-sensory-stimulation-below-lesion-in-human-spinal-cord-injury
#7
Rachael Brown, Alexander R Burton, Vaughan G Macefield
Autonomic dysreflexia is a dangerous elevation in blood pressure in people with spinal cord injury (SCI), produced by a spinally-mediated reflex activation of sympathetic vasoconstrictor neurones supplying skeletal muscle and the gut. Current dogma states that, apart from visceral inputs - such as those originating from a distended bladder or impacted colon - autonomic dysreflexia is triggered by noxious inputs below the lesion. However, while selective stimulation of small-diameter afferents in muscle or skin evokes a sustained increase in muscle sympathetic nerve activity and blood pressure, and a transient increase in skin sympathetic nerve activity and decrease in skin blood flow in able-bodied subjects, such noxious inputs have no effects on blood pressure and skin blood flow in SCI individuals...
July 13, 2017: Autonomic Neuroscience: Basic & Clinical
https://www.readbyqxmd.com/read/28699368/impact-of-blood-pressure-lesion-level-and-physical-activity-on-aortic-augmentation-index-in-persons-with-sci
#8
Caitlyn G Katzelnick, Joseph P Weir, Nancy Chiaravalotti, Glenn Wylie, Trevor Dyson-Hudson, William A Bauman, Jill M Wecht
Individuals with chronic spinal cord injury (SCI) are at a heightened risk of cardiovascular disease (CVD) due to autonomic nervous system dysfunction, physical inactivity and increased inflammatory processes. Arterial stiffness (AS) is recognized as an independent risk factor for CVD and, specifically, pulse wave analysis (PWA) has proven to be a useful tool to predict and track structural arterial changes that reflect arteriosclerosis. The augmentation index (AI) can be used to estimate AS and is derived from the amplitude and timing of the blood pressure (BP) wave reflection in a peripheral artery...
July 12, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/28666000/dynamic-wheelchair-seating-positions-impact-cardiovascular-function-after-spinal-cord-injury
#9
Jessica A Inskip, Henrike Rianne J C Ravensbergen, Inderjeet S Sahota, Christine Zawadzki, Lowell T McPhail, Jaimie F Borisoff, Victoria E Claydon
BACKGROUND: Innovative wheelchairs allow individuals to change position easily for comfort and social situations. While these wheelchairs are beneficial in multiple ways, the effects of position changes on blood pressure might exacerbate hypotension and cerebral hypoperfusion, particularly in those with spinal cord injury (SCI) who can have injury to autonomic nerves that regulate cardiovascular control. Conversely, cardiovascular benefits may be obtained with lowered seating. Here we investigate the effect of moderate changes in wheelchair position on orthostatic cardiovascular and cerebrovascular reflex control...
2017: PloS One
https://www.readbyqxmd.com/read/28660164/epidemiology-of-trauma-victims-admitted-to-a-level-2-trauma-center-of-north-india
#10
Vikas Verma, Ajay Singh, Girish Kumar Singh, Santosh Kumar, Vineet Sharma, Ashish Kumar, Vineet Kumar
BACKGROUND: Good quality information on characteristics of victims, types, and frequency of injuries, causes of accidents, vehicles involved in injury and outcome is essential for understanding and planning required for managing the trauma epidemic. The objective of this study was to describe the characteristics of trauma victims admitted to King George's Medical University trauma center. METHODS: This observational study enrolled trauma victims over a 1-year period...
April 2017: International Journal of Critical Illness and Injury Science
https://www.readbyqxmd.com/read/28605971/impaired-baroreflex-function-during-orthostatic-challenge-in-patients-after-spinal-cord-injury
#11
Katarina Ondrusova, Jana Svacinova, Michal Javorka, Jan Novak, Marie Novakova, Zuzana Novakova
The level of spinal cord injury (SCI) affects baroreflex regulation of blood pressure. While a parasympathetic cardiac chronotropic effect is preserved, baroreflex response could be impaired by sympathetic dysfunction under the SCI level. This study was aimed to evaluate the baroreflex function in SCI patients by the analysis of causal interaction between systolic blood pressure (SBP) and inter-beat intervals (IBI). Blood pressure was continuously recorded in 13 cervical SCI patients (CSCI), nine thoracic SCI (ThSCI) and 13 able-bodied controls (Con) during two phases: sitting (PS) and orthostatic challenge (PO)...
August 18, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/28585557/pharmacodynamics-and-effectiveness-of-topical-nitroglycerin-at-lowering-blood-pressure-during-autonomic-dysreflexia
#12
R Solinsky, A E Bunnell, T A Linsenmeyer, J N Svircev, A Engle, S P Burns
STUDY DESIGN: Secondary analysis of prospectively collected observational data assessing the safety of an autonomic dysreflexia (AD) management protocol. OBJECTIVES: To estimate the time to onset of action, time to full clinical effect (sustained systolic blood pressure (SBP) <160 mm Hg) and effectiveness of nitroglycerin ointment at lowering blood pressure for patients with spinal cord injuries experiencing AD. SETTING: US Veterans Affairs inpatient spinal cord injury (SCI) unit...
June 6, 2017: Spinal Cord
https://www.readbyqxmd.com/read/28571527/assessment-and-management-of-acute-spinal-cord-injury-from-point-of-injury-to-rehabilitation
#13
Laureen D Hachem, Christopher S Ahuja, Michael G Fehlings
CONTEXT: Spinal cord injury (SCI) is a devastating condition that can lead to significant neurological impairment and reduced quality of life. Despite advancements in our understanding of the pathophysiology and secondary injury mechanisms involved in SCI, there are currently very few effective treatments for this condition. The field, however, is rapidly changing as new treatments are developed and key discoveries are made. METHODS: In this review, we outline the pathophysiology, management, and long-term rehabilitation of individuals with traumatic SCI...
June 1, 2017: Journal of Spinal Cord Medicine
https://www.readbyqxmd.com/read/28537464/multi-domain-assessment-of-autonomic-function-in-spinal-cord-injury-using-a-modified-autonomic-reflex-screen
#14
Michael J Berger, Kurt Kimpinski, Katharine D Currie, Hirmand Nouraei, Mahsa Sadeghi, Andrei V Krassioukov
The aim of this study was to characterize autonomic lesions in participants with spinal cord injury (SCI; n = 10) using an autonomic reflex screen, incorporating sudomotor, cardiovagal, and sympathetic adrenergic tests, as well as hemodynamic responses to head-up tilt (HUT). Hemodynamic responses were compared to healthy controls (n = 20) and previously published normative cutoffs in order better identify autonomic impairments. Sympathetic skin responses (SSRs), heart rate response to deep breathing (HRDB), and heart rate and beat-to-beat blood pressure responses to Valsalva maneuver (VM) and HUT were measured...
July 21, 2017: Journal of Neurotrauma
https://www.readbyqxmd.com/read/28486884/effect-of-intravesical-botulinum-toxin-injection-on-symptoms-of-autonomic-dysreflexia-in-a-patient-with-chronic-spinal-cord-injury-a-case-report
#15
Il-Young Jung, Kyo Ik Mo, Ja-Ho Leigh
CONTEXT: There are few treatment options for managing autonomic dysreflexia in patients with chronic spinal cord injury (SCI). According to some studies, intravesical botulinum toxin for SCI patients with autonomic dysreflexia has a preventive effect on symptoms of autonomic dysreflexia. However, the usefulness of an intravesical botulinum toxin injection has never been reported for autonomic dysreflexia in an adult patient with chronic cervical SCI, although there has been for one pediatric patient...
May 9, 2017: Journal of Spinal Cord Medicine
https://www.readbyqxmd.com/read/28469668/anesthetic-considerations-for-patients-with-acute-cervical-spinal-cord-injury
#16
REVIEW
Fang-Ping Bao, Hong-Gang Zhang, Sheng-Mei Zhu
Anesthesiologists work to prevent or minimize secondary injury of the nervous system and improve the outcome of medical procedures. To this end, anesthesiologists must have a thorough understanding of pathophysiology and optimize their skills and equipment to make an anesthesia plan. Anesthesiologists should conduct careful physical examinations of patients and consider neuroprotection at preoperative interviews, consider cervical spinal cord movement and compression during airway management, and suggest awake fiberoptic bronchoscope intubation for stable patients and direct laryngoscopy with manual in-line immobilization in emergency situations...
March 2017: Neural Regeneration Research
https://www.readbyqxmd.com/read/28447605/traumatic-spinal-cord-injury
#17
REVIEW
Christopher S Ahuja, Jefferson R Wilson, Satoshi Nori, Mark R N Kotter, Claudia Druschel, Armin Curt, Michael G Fehlings
Traumatic spinal cord injury (SCI) has devastating consequences for the physical, social and vocational well-being of patients. The demographic of SCIs is shifting such that an increasing proportion of older individuals are being affected. Pathophysiologically, the initial mechanical trauma (the primary injury) permeabilizes neurons and glia and initiates a secondary injury cascade that leads to progressive cell death and spinal cord damage over the subsequent weeks. Over time, the lesion remodels and is composed of cystic cavitations and a glial scar, both of which potently inhibit regeneration...
April 27, 2017: Nature Reviews. Disease Primers
https://www.readbyqxmd.com/read/28447274/classification-and-regression-tree-model-for-predicting-tracheostomy-in-patients-with-traumatic-cervical-spinal-cord-injury
#18
Dae-Sang Lee, Chi-Min Park, Keumhee Chough Carriere, Joonghyun Ahn
PURPOSE: In patients with cervical spinal cord injury (CSCI), respiratory compromise and the need for tracheostomy are common. The purpose of this study was to identify common risk factors for tracheostomy following traumatic CSCI and develop a decision tree for tracheostomy in traumatic CSCI patients without pulmonary function test. METHODS: Data of 105 trauma patients with CSCI admitted in our institution from April, 2008 to February, 2014 were retrospectively analyzed...
April 26, 2017: European Spine Journal
https://www.readbyqxmd.com/read/28416148/alterations-in-autonomic-cerebrovascular-control-after-spinal-cord-injury
#19
Dong-Il Kim, Can Ozan Tan
Among chronic cardiovascular and metabolic sequelae of spinal cord injury (SCI) is an up-to four-fold increase in the risk of ischemic and hemorrhagic stroke, suggesting that individuals with SCI cannot maintain stable cerebral perfusion. In able-bodied individuals, the cerebral vasculature is able to regulate cerebral perfusion in response to swings in arterial pressure (cerebral autoregulation), blood gases (cerebral vasoreactivity), and neural metabolic demand (neurovascular coupling). This ability depends, at least partly, on intact autonomic function, but high thoracic and cervical spinal cord injuries result in disruption of sympathetic and parasympathetic cerebrovascular control...
April 4, 2017: Autonomic Neuroscience: Basic & Clinical
https://www.readbyqxmd.com/read/28351230/continuous-monitoring-and-visualization-of-optimum-spinal-cord-perfusion-pressure-in-patients-with-acute-cord-injury
#20
Suliang Chen, Peter Smielewski, Marek Czosnyka, Marios C Papadopoulos, Samira Saadoun
The optimum spinal cord perfusion pressure (SCPP) after traumatic spinal cord injury (TSCI) is unknown. Here, we describe techniques to compute and display the optimum SCPP in real time. We recruited adults within 72 h of severe TSCI (American Spinal Injuries Association [ASIA] grades A-C). A pressure probe and a microdialysis catheter were placed on the injured cord. SCPP was computed as mean arterial pressure (MAP) minus intraspinal pressure (ISP), spinal pressure reactivity index (sPRx) as the running ISP/MAP correlation coefficient, and continuous optimum SCPP (cSCPPopt) as the SCPP that minimizes sPRx in a moving 4-h window...
May 24, 2017: Journal of Neurotrauma
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