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Other Guidelines
Physical and rehabilitation medicine (PRM) care pathways: “Spinal cord injury”
This document is part of a series of documents designed by the French Physical and Rehabilitation Medicine Society (SOFMER) and the French Federation of PRM (FEDMER). These documents describe the needs for or a specific type of patients; PRM care objectives, human and material resources to be implemented, chronology as well as expected outcomes. “Care pathways in PRM” is a short document designed to enable the reader (physicians, decision-maker, administrator, lawyer or finance manager) to quickly apprehend the needs of these patients and the available therapeutic care structures for proper organization and pricing of these activities. The patients after spinal cord injury are divided into five categories according to the severity of the impairments, each one being treated according to the same six parameters according to the International Classification of Functioning, Disability and Health (WHO), while taking into account personal and environmental factors that could influence the needs of these patients.
The acute cardiopulmonary management of patients with cervical spinal cord injuries. In: Guidelines for the management of acute cervical spine and spinal cord injuries.
Patients with acute cervical SCI frequently develop hypotension, hypoxemia, pulmonary dysfunction, and cardiovascular instability, often despite initial stable cardiac and pulmonary function. These complications are not limited to patients with complete SCI. Life threatening cardiovascular instability and respiratory insufficiency may be transient and episodic and may be recurrent in the first 7 to 10 days after injury. Patients with the most severe neurological injuries appear to have the greatest risk of these life-threatening events. Class III medical evidence indicates that ICU monitoring allows the early detection of hemodynamic instability, cardiac disturbances, pulmonary dysfunction, and hypoxemia. Prompt treatment of these events in patients with acute SCI reduces cardiac- and respiratory-related morbidity and mortality.
Management in an ICU or other monitored setting appears to have an impact on neurological outcome after acute cervical SCI. Retrospective studies consistently report that volume expansion and blood pressure augmentation performed under controlled circumstances in an ICU setting are linked to improved American Spinal Injury Association (ASIA) scores in patients with acute SCI compared with historical controls. Class III medical evidence suggests that the maintenance of mean arterial pressure (MAP) at 85 to 90 mmHg after acute SCI for a duration of 7 days is safe and may improve spinal cord perfusion and ultimately neurological outcome.
