Autonomic dysreflexia: Current pharmacologic management.
Journal
PM & R : the journal of injury, function, and rehabilitation
ISSN: 1934-1563
Titre abrégé: PM R
Pays: United States
ID NLM: 101491319
Informations de publication
Date de publication:
06 Aug 2023
06 Aug 2023
Historique:
revised:
26
06
2023
received:
06
05
2023
accepted:
24
07
2023
pubmed:
7
8
2023
medline:
7
8
2023
entrez:
7
8
2023
Statut:
aheadofprint
Résumé
Autonomic dysreflexia (AD) is a frequent complication of spinal cord injury (SCI), though current clinical practice patterns for medication management of this condition are unknown. Correspondingly, it is unclear if national differences in practice patterns exist. To determine trends in current pharmacologic management of AD throughout the Americas. International survey of current physician practice patterns. Academic medical center. Sixty physicians managing patients with SCI and prescribing medications to manage AD. Not applicable. Presence of a formal pharmacologic AD management protocol, first- and second-line medications, patient characteristics influencing pharmacologic management. The majority of physicians (69%) had a formal AD management protocol for inpatient care, with nitroglycerin ointment (82%) being the most common first-line medication. Strong national differences existed regarding the use of nitroglycerin ointment, with 98% of U.S.-based physicians using this as first-line medication and 0% of physicians in Canada or Latin America using this due to recent lack of medication availability. Only 67% of physicians had a preferred second-line medication, with preferences split between hydralazine (48%) and nifedipine (28%). A systolic blood pressure threshold for pharmacologic management was used by 56% of physicians, wheres 26% considered neurological level of injury in decisions to use medications for AD. Heart rate was used by only 5% of physicians in their decision to manage AD with medications. As of 2023, U.S.-based physicians caring for individuals with SCI largely have formal inpatient protocols in place for medication management of AD, with nearly all relying on nitroglycerin ointment as their first-line medication. In areas outside of the United States where nitroglycerin ointment is unavailable, pharmacologic practice patterns significantly differ.
Sections du résumé
BACKGROUND
BACKGROUND
Autonomic dysreflexia (AD) is a frequent complication of spinal cord injury (SCI), though current clinical practice patterns for medication management of this condition are unknown. Correspondingly, it is unclear if national differences in practice patterns exist.
OBJECTIVE
OBJECTIVE
To determine trends in current pharmacologic management of AD throughout the Americas.
DESIGN
METHODS
International survey of current physician practice patterns.
SETTING
METHODS
Academic medical center.
PARTICIPANTS
METHODS
Sixty physicians managing patients with SCI and prescribing medications to manage AD.
INTERVENTIONS
METHODS
Not applicable.
MAIN OUTCOME MEASURES
METHODS
Presence of a formal pharmacologic AD management protocol, first- and second-line medications, patient characteristics influencing pharmacologic management.
RESULTS
RESULTS
The majority of physicians (69%) had a formal AD management protocol for inpatient care, with nitroglycerin ointment (82%) being the most common first-line medication. Strong national differences existed regarding the use of nitroglycerin ointment, with 98% of U.S.-based physicians using this as first-line medication and 0% of physicians in Canada or Latin America using this due to recent lack of medication availability. Only 67% of physicians had a preferred second-line medication, with preferences split between hydralazine (48%) and nifedipine (28%). A systolic blood pressure threshold for pharmacologic management was used by 56% of physicians, wheres 26% considered neurological level of injury in decisions to use medications for AD. Heart rate was used by only 5% of physicians in their decision to manage AD with medications.
CONCLUSIONS
CONCLUSIONS
As of 2023, U.S.-based physicians caring for individuals with SCI largely have formal inpatient protocols in place for medication management of AD, with nearly all relying on nitroglycerin ointment as their first-line medication. In areas outside of the United States where nitroglycerin ointment is unavailable, pharmacologic practice patterns significantly differ.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Eunice Kennedy Shriver National Institute of Child Health and Human Development
ID : K23HD102663
Informations de copyright
© 2023 American Academy of Physical Medicine and Rehabilitation.
Références
Linsenmeyer TA, Gibbs K, Solinsky R. Autonomic dysreflexia after spinal cord injury: beyond the basics. Curr Phys Med. 2020;8(4):443-451.
McBride F, Quah SP, Scott ME, Dinsmore WW. Tripling of blood pressure by sexual stimulation in a man with spinal cord injury. J R Soc Med. 2003;96(7):349-350.
Vallès M, Benito J, Portell E, Vidal J. Cerebral hemorrhage due to autonomic dysreflexia in a spinal cord injury patient. Spinal Cord. 2005;43(12):738-740.
Kiker JD, Woodside JR, Jelinek GE. Neurogenic pulmonary edema associated with autonomic dysreflexia. J Urol. 1982;128(5):1038-1039.
Dolinak D, Balraj E. Autonomic dysreflexia and sudden death in people with traumatic spinal cord injury. Am J Forensic Med Pathol. 2007;28(2):95-98.
Linsenmeyer T. Acute management of autonomic dysreflexia: adults with spinal cord injury presenting to health-care facilities. J Spinal Cord Med. 1997;20(3):284-309.
Linsenmeyer TA, Baker ER, Cardenas DD, et al. Acute management of autonomic dysreflexia: individuals with spinal cord injury presenting to health-care facilities. Consortium for spinal cord medicine clinical practice guidelines. 2nd ed. clinical practice guidelines. J Spinal Cord Med. 2002;25(1):S68-S88.
Krassioukov A, Linsenmeyer TA, Beck LA, et al. Evaluation and management of autonomic dysreflexia and other autonomic dysfunctions: preventing the highs and lows: management of blood pressure, sweating, and temperature dysfunction. J Spinal Cord Med. 2021;44(4):631-683.
Braddom RL, Rocco JF. Autonomic Dysreflexia: a survey of current treatment. Am J Phys Med Rehabil. 1991;7(5):234-241.
Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med. 1997;157:2413-2445.
Solinsky R, Svircev JN, James JJ, Burns SP, Bunnell AE. A retrospective review of safety using a nursing driven protocol for autonomic dysreflexia in patients with spinal cord injuries. J Spinal Cord Med. 2016;39(6):713-719.
Solinsky R, Bunnell AE, Linsenmeyer TA, Svircev JN, Engle A, Burns SP. Pharmacodynamics and effectiveness of topical nitroglycerin at lowering blood pressure during autonomic dysreflexia. Spinal Cord. 2017;55(10):911-914.
Reitz A, Knapp PA, Müntener M, Schurch B. Oral nitric oxide donors: a new pharmacological approach to detrusor-sphincter dyssynergia in spinal cord injured patients? Eur Urol. 2004;45(4):516-520.
Solinsky R, Kirshblum SC, Burns SP. Exploring detailed characteristics of autonomic dysreflexia. J Spinal Cord Med. 2018;41(5):549-555.
Koyuncu E, Ersoz M. Monitoring development of autonomic dysreflexia during urodynamic investigation in patients with spinal cord injury. J Spinal Cord Med. 2016;40(2):170-174.