Critical Care of Spinal Cord Injury.

Sabrina L Zeller, Alan Stein, Ilya Frid, Austin B Carpenter, Sauson Soldozy, Cameron Rawanduzy, Jon Rosenberg, Andrew Bauerschmidt, Fawaz Al-Mufti, Stephan A Mayer, Merritt D Kinon, John V Wainwright

Current neurology and neuroscience reports 2024 Sep

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Spinal cord injury (SCI) is a major cause of morbidity and mortality, posing a significant financial burden on patients and the healthcare system. While little can be done to reverse the primary mechanical insult, minimizing secondary injury due to ischemia and inflammation and avoiding complications that adversely affect neurologic outcome represent major goals of management. This article reviews important considerations in the acute critical care management of SCI to improve outcomes. Neuroprotective agents, such as riluzole, may allow for improved neurologic recovery but require further investigation at this time. Various forms of neuromodulation, such as transcranial magnetic stimulation, are currently under investigation. Early decompression and stabilization of SCI is recommended within 24 h of injury when indicated. Spinal cord perfusion may be optimized with a mean arterial pressure goal from a lower limit of 75-80 to an upper limit of 90-95 mmHg for 3-7 days after injury. The use of corticosteroids remains controversial; however, initiation of a 24-h infusion of methylprednisolone 5.4 mg/kg/hour within 8 h of injury has been found to improve motor scores. Attentive pulmonary and urologic care along with early mobilization can reduce in-hospital complications. © 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Citation

Sabrina L Zeller, Alan Stein, Ilya Frid, Austin B Carpenter, Sauson Soldozy, Cameron Rawanduzy, Jon Rosenberg, Andrew Bauerschmidt, Fawaz Al-Mufti, Stephan A Mayer, Merritt D Kinon, John V Wainwright. Critical Care of Spinal Cord Injury. Current neurology and neuroscience reports. 2024 Sep;24(9):355-363