What is the goal systolic blood pressure (SBP) in patients with Spinal Cord Injury (SCI)?

From the Guidelines

The goal systolic blood pressure (SBP) in patients with Spinal Cord Injury (SCI) should be maintained above 90 mmHg, particularly during the acute phase, to minimize secondary injury and ensure adequate spinal cord perfusion. This recommendation is based on the American Association of Neurological Surgeons/Congress of Neurological Surgeons guidelines, which suggest banning arterial hypotension (SBP < 90 mmHg) until day 5-7 after injury 1. Although there are no randomized controlled trials comparing neurological prognosis to a specific blood pressure objective, expert opinion and retrospective studies support the importance of maintaining adequate blood pressure to prevent ischemia and preserve neurological function.

Key considerations in managing blood pressure in SCI patients include:

• Avoiding hypotension, defined as SBP < 110 mmHg, which is an independent factor of patient mortality after spinal cord injury 1
• Targeting mean blood pressure (MAP) > 85 mmHg within the first 5 to 7 days, although the evidence for this is limited and based on prospective interventional studies without control groups 1
• Continuously monitoring MAP with an arterial catheter, as it can be difficult to achieve target MAP levels 1
• Maintaining a spinal perfusion pressure > 50 mmHg, which has been correlated with better neurological status at 6 months 1

In clinical practice, if blood pressure falls below the target threshold, vasopressors such as norepinephrine or dopamine may be initiated promptly, along with fluid resuscitation with crystalloids like normal saline. Regular monitoring of blood pressure, heart rate, and neurological status is essential to guide management and adjust treatment as needed.

From the Research

Goal Systolic Blood Pressure (SBP) in Spinal Cord Injury (SCI)

• The goal SBP in patients with SCI is not explicitly stated in the provided studies, but we can look at the systolic blood pressure values mentioned in the context of various conditions and management strategies.
• In the study 2, the focus is on mean arterial pressure (MAP) goals rather than SBP directly, suggesting MAP goals of 85-90 mm Hg for a duration of 5-7 days based on the highest level of evidence available.
• The study 3 discusses BP instability in chronic SCI, evaluating stability by deviation of systolic BP from 115 mmHg and the percentage of systolic BP measurements within 90-140 mmHg, indicating that a significant portion of participants had measurements outside this range.
• In 4, significant hypertension during voiding is defined by systolic blood pressure greater than 160 mm Hg or diastolic blood pressure greater than 90 mm Hg, with a notable absence of symptoms in some cases.
• The study 5 mentions systolic blood pressure elevations >20 mmHg as an indicator of autonomic dysreflexia, without specifying a goal SBP but highlighting the importance of blood pressure monitoring.
• Lastly, 6 describes cases of hypertension in paraplegia with resting blood pressure lower than in the normal population, but does not provide a specific goal SBP for SCI management.

Considerations for Goal SBP

• The provided studies do not offer a clear, universally applicable goal SBP for patients with SCI.
• Management strategies and blood pressure goals may vary based on the individual's condition, the level and completeness of the injury, and the presence of other health issues.
• Blood pressure instability and the risk of autonomic dysreflexia are significant concerns in SCI patients, suggesting the need for personalized and vigilant management strategies 3, 4, 5.