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Squair et al. studied whether spinal cord perfusion pressure (SCPP) as measured with a lumbar intrathecal catheter was a more predictive measure of neurologic outcome than the conventionally measured mean arterial pressure (MAP). They found that maintaining SCPP above 50 mm Hg was a strong predictor of improved neurologic recovery following spinal cord injury and suggested that SCPP could provide useful information to guide the hemodynamic management of patients with acute spinal cord injury. Dr. Satyarthee critiques the article, stating that SCPP is a dynamic process and that the study had limitations such as the small sample size, short observation period, and arbitrary 50 mm Hg SCPP critical point labeling. Squair et al. concur that further work is needed to define the role of SCPP monitoring in acute spinal cord injury. However, they explain that the 50 mm Hg SCPP point was not chosen arbitrarily; rather it was determined by statistically examining all possible cutoffs associated with poor neurologic outcome. They also add that the MAP goal of 85–90 mm Hg recommended in the 2013 guidelines cited by Dr. Satyarthee were based upon 2 studies with cohorts considerably smaller than the current study.
Squair et al. studied whether spinal cord perfusion pressure (SCPP) as measured with a lumbar intrathecal catheter was a more predictive measure of neurologic outcome than the conventionally measured mean arterial pressure (MAP). They found that maintaining SCPP above 50 mm Hg was a strong predictor of improved neurologic recovery following spinal cord injury and suggested that SCPP could provide useful information to guide the hemodynamic management of patients with acute spinal cord injury. Dr. Satyarthee critiques the article, stating that SCPP is a dynamic process and that the study had limitations such as the small sample size, short observation period, and arbitrary 50 mm Hg SCPP critical point labeling. Squair et al. concur that further work is needed to define the role of SCPP monitoring in acute spinal cord injury. However, they explain that the 50 mm Hg SCPP point was not chosen arbitrarily; rather it was determined by statistically examining all possible cutoffs associated with poor neurologic outcome. They also add that the MAP goal of 85–90 mm Hg recommended in the 2013 guidelines cited by Dr. Satyarthee were based upon 2 studies with cohorts considerably smaller than the current study.
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Author disclosures are available upon request (journal{at}neurology.org).
- © 2018 American Academy of Neurology
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