Mean Arterial Pressure Management in Spinal Cord Injury Patients Undergoing Cervical Spine Surgery
Current Evidence on MAP Targets
- The American Association of Neurological Surgeons/Congress of Neurological Surgeons recommends targeting supra-physiological MAP > 85 mmHg within the first 5-7 days after spinal cord injury, though this recommendation is based on limited evidence 3, 4
- The 2019 Congress of Neurological Surgeons guidelines acknowledge that while scientific data supporting MAP augmentation are mainly derived from cervical SCI studies, clinicians may choose to maintain MAP > 85 mmHg to improve neurological outcomes 1, 5, 2
- French guidelines from 2020 suggest a more conservative approach, recommending MAP > 70 mmHg during the first week after injury, noting insufficient evidence to recommend levels over 70 mmHg 3, 6, 7
Duration of MAP Augmentation
- Most guidelines and studies recommend maintaining elevated MAP for 5-7 days post-injury 1, 2
- The correlation between MAP level and neurological improvement appears strongest in the first 2-3 days after admission 3, 4
Practical Considerations and Caveats
- Continuous arterial pressure monitoring via arterial catheter is recommended as studies show MAP is below target approximately 25% of the time without close monitoring 3, 4