Elevating Blood Pressure After Spinal Cord Injury Fails to Improve Recovery
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DURHAM, N.C. – Spinal cord injury is one of the leading causes of long-term disability worldwide, often impacting young people who face a lifetime of physical and neurological challenges ahead. A new study questions a widely accepted treatment strategy in the critical first days after injury, findings that could reshape ICU protocols and improve patient outcomes.
The study, one of the largest of its kind and led by researchers at Duke Health, found that elevating blood pressure beyond normal levels in the first week after a spinal cord injury may not improve neurological recovery while increasing complications.
Results are being presented September 18 at the Neurocritical Care Society Annual Meeting in Montreal and simultaneously published in JAMA Network Open.
“As an ICU physician, I’ve often questioned whether pushing higher blood pressure was truly helping my patients,” said senior author Miriam Treggiari, M.D., professor in the Department of Anesthesiology at Duke University School of Medicine. “This study was born out of that clinical concern of side effects while trying to achieve targets that may not reflect meaningful benefit.”
For more than a decade, clinicians have followed recommendations to augment blood pressure above normal in spinal cord injury patients for up to seven days after the injury, aiming to enhance spinal cord perfusion and recovery.
For this study, researchers examined patients receiving conventional versus augmented blood pressure targets and found no difference in motor or sensory recovery after six months. However, those in the augmented group experienced significantly more respiratory complications, longer mechanical ventilation, and greater organ dysfunction.
“Implementing an augmented blood pressure treatment regimen involves invasive procedures and a prolonged stay in intensive care, which adds more healthcare costs and demand on clinicians,” said first author Ruba Sajdeya, M.D., medical instructor in the Department of Anesthesiology. “So, the question is – is it worth it?”
The multicenter randomized clinical trial led by researchers at Duke Health enrolled 92 adults with acute spinal cord injury across a dozen major trauma centers in the U.S. Participants were randomized to receive either standard care blood pressure management or blood pressure augmentation for up to seven days in the ICU. Researchers assessed neurological function six months after injury, in addition to pain, functional independence, and quality of life, and tracked complications during hospitalization including pneumonia, ventilator time, and organ stress.
“It’s really encouraging to see that many patients have potential for improvement from the time they’re admitted to the hospital,” said Treggiari. “We do see the large majority recover some degree of function. This reflects ongoing advancements in the way we deliver care for these patients.”
In addition to Treggiari and Sajdeya, study authors include N. David Yanez, Michael Kampp, Michael D. Goodman, David Zonies, Brandon Togioka, Andrew Nunn, Robert D. Winfield, Niels D. Martin, Anirudh Kohli, Toan T. Huynh, David O. Okonkwo, Roy A. Poblete, Emily J. Gilmore, Randall M. Chesnut, Aaron E. Bunnell, Tetsu Ohnuma, Mona Hashemaghaie.
This work was supported by the Office of the Assistant Secretary of Defense for Health Affairs, through the Spinal Cord Research Program under Award No. W81XWH-16-1-0748. Opinions, interpretations, conclusions and recommendations are those of the author and are not necessarily endorsed by the Department of Defense.