B. Harris1, E. Zafross1, K. Petros1, J. Garavaglia1, J. Bardes1 1WEST VIRGINIA UNIVERSITY, SURGERY, Morgantown, WV, USA
Introduction:
Acute spinal cord injuries (SCI) can result in significant morbidity for inflicted patients. Current guidelines recommend blood pressure augmentation to MAP of 85 to 90 mmHg to prevent hypoperfusion. Although there is no consensus on a single vasoactive agent, intravenous (IV) vasopressors are commonly utilized. This requires care in an intensive care unit (ICU) which contributes to the large financial burden of this injury. Oral (PO) agents such as pseudoephedrine and midodrine are also utilized but little data is available evaluating the impact of these agents. This study investigates the use and dosing of oral (PO) vasoactive agents as an alternative in blood pressure augmentation in SCI.
Methods:
Patients 18 years or older at a single institution with SCI treated with norepinephrine, phenylephrine, dopamine, pseudoephedrine, or midodrine were included. Total daily dose was evaluated as well as ICU and hospital length of stay (LOS).
Results:
104 patients were evaluated. 20.2% receive IV agents only while 73.1% were transitioned from IV to PO. 6.7% received only PO agents. Patients receiving PO agents only had shorter ICU and hospital LOS (4 and 7 days respectively) compared to patients receiving IV agents only (6 and 10 days) or those transitioned to PO agents after a period of IV vasopressors (7 and 12 days). Median doses were 120 mg pseudoephedrine and 30 mg midrodrine.
Conclusion:
We found PO agents were associated with shorter ICU and hospital LOS in SCI. This difference was seen both when comparing to patients who received IV pressors alone and those initially treated with IV pressors but later transitioned to PO agents. This suggests IV vasopressors may not be needed for all patients, but instead, PO agents could be utilized to decrease the financial burden placed on patients and healthcare systems from lengthy ICU and hospital courses. Interestingly, this benefit was accomplished with lower than previously reported doses of PO agents. This study is limited by the fact that it is the experience of only one institution and the sample size is relatively small.
