Thermodilution for hemodynamic monitoring after acute spinal cord injury

Status:

completed 03/2020

Aims:

Advanced hemodynamic monitoring using thermodilution is a recognized procedure in intensive care medicine. Due to the affection of the autonomic nervous system a spinal cord injury (SCI) causes vasoplegia of the peripheral vessels and bradycardia, therefore severely affecting the cardiovascular system. To date, no publication describes the applicability of advanced hemodynamic monitoring in these patients. Aim: What are the values for cardiac performance (cardiac output, stroke volume, heart rate) and systemic vascular resistance in patients with SCI? How do they differ from the published reference values of non-paraplegic patients?

Activities/Methods:

From March 2018 until March 2020 we conducted a prospective, single center pilot study including all patients with an acute SCI (n=30). We excluded patients that had a pre-existing cardiac condition as well as patients suffering from sepsis. Measurements (n=417) were performed using the PiCCO system (Pulsion, Munich, Germany) at least 3 times a day.

Results:

Until March of 2020 30 patients were included. In 21 patients the levels of C2 to C7 were affected. Six patients had a lesion of the thoracic level and 3 subjects suffered from lumbar paraplegia. Overall, the mean Cardiac Index (CI), the mean Stroke Volume Index (SI), the mean Heart Rate (HR) and the Mean Arterial Pressure (MAP) were within the reference range found in the literature. Only the mean Systemic Vascular Resistance Index (SVRI) and the mean Central Venous Pressure (CVP) deviated from the norm. There were 19 patients requiring norepinephrine on at least one day of measurements (n=86). Compared to the measurements taken without vasopressor therapy (n=300) we observed a significantly lower mean CI (3.9 vs 4.2 l/min/m2, p=0.03), SI (55 vs 59 ml/m2, p=0.014), SVRI (1275 vs 1422 dyn*s*cm-5*m2, p=0.01) und MAP (71 vs 83 mmHg, p=0.00). The mean HR 73 vs 73 bpm, p=0.97) and the mean CVP (11 vs 11 mmHg, p=0.66) were unaffected.

Conclusion:
Our results show a difference of the mean SVRI in patients suffering from acute SCI when compared to the reference range of healthy individuals. Furthermore, the SVRI is reduced in subjects under norepinephrine therapy and patients that did not receive catecholamines. Both CI and SI are on the upper margin of the reference range and seem to compensate for the loss of vascular resistance. Overall, these findings could lead to an adaptation of the reference range of SVRI and MAP in patients with acute SCI and therefore reduce the use of catecholamines.

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