R Solinsky1,2,3, A E Bunnell3,4, T A Linsenmeyer1,2,5, J N Svircev3,6, A Engle7, S P Burns3,6. 1. Kessler Institute for Rehabilitation, West Orange, NJ, USA. 2. Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA. 3. Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA. 4. Harborview Medical Center, Seattle, WA, USA. 5. Department of Surgery, Division of Urology, Rutgers New Jersey Medical School, Newark, NJ, USA. 6. Spinal Cord Injury Service, Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA. 7. Department of Statistics, University of Washington, Seattle, WA, USA.
Abstract
STUDY DESIGN: Secondary analysis of prospectively collected observational data assessing the safety of an autonomic dysreflexia (AD) management protocol. OBJECTIVES: To estimate the time to onset of action, time to full clinical effect (sustained systolic blood pressure (SBP) <160 mm Hg) and effectiveness of nitroglycerin ointment at lowering blood pressure for patients with spinal cord injuries experiencing AD. SETTING: US Veterans Affairs inpatient spinal cord injury (SCI) unit. METHODS: Episodes of AD recalcitrant to nonpharmacologic interventions that were given one to two inches of 2% topical nitroglycerin ointment were recorded. Pharmacodynamics as above and predictive characteristics (through a mixed multivariate logistic regression model) were calculated. RESULTS: A total of 260 episodes of pharmacologically managed AD were recorded in 56 individuals. Time to onset of action for nitroglycerin ointment was 9-11 min. Time to full clinical effect was 14-20 min. Topical nitroglycerin controlled SBP <160 mm Hg in 77.3% of pharmacologically treated AD episodes with the remainder requiring additional antihypertensive medications. A multivariate logistic regression model was unable to identify statistically significant factors to predict which patients would respond to nitroglycerin ointment (odds ratios 95% confidence intervals 0.29-4.93). The adverse event rate, entirely attributed to hypotension, was 3.6% with seven of the eight events resolving with close observation alone and one episode requiring normal saline. CONCLUSIONS: Nitroglycerin ointment has a rapid onset of action and time to full clinical effect with high efficacy and relatively low adverse event rate for patients with SCI experiencing AD.
STUDY DESIGN: Secondary analysis of prospectively collected observational data assessing the safety of an autonomic dysreflexia (AD) management protocol. OBJECTIVES: To estimate the time to onset of action, time to full clinical effect (sustained systolic blood pressure (SBP) <160 mm Hg) and effectiveness of nitroglycerin ointment at lowering blood pressure for patients with spinal cord injuries experiencing AD. SETTING: US Veterans Affairs inpatient spinal cord injury (SCI) unit. METHODS: Episodes of AD recalcitrant to nonpharmacologic interventions that were given one to two inches of 2% topical nitroglycerin ointment were recorded. Pharmacodynamics as above and predictive characteristics (through a mixed multivariate logistic regression model) were calculated. RESULTS: A total of 260 episodes of pharmacologically managed AD were recorded in 56 individuals. Time to onset of action for nitroglycerin ointment was 9-11 min. Time to full clinical effect was 14-20 min. Topical nitroglycerin controlled SBP <160 mm Hg in 77.3% of pharmacologically treated AD episodes with the remainder requiring additional antihypertensive medications. A multivariate logistic regression model was unable to identify statistically significant factors to predict which patients would respond to nitroglycerin ointment (odds ratios 95% confidence intervals 0.29-4.93). The adverse event rate, entirely attributed to hypotension, was 3.6% with seven of the eight events resolving with close observation alone and one episode requiring normal saline. CONCLUSIONS:Nitroglycerin ointment has a rapid onset of action and time to full clinical effect with high efficacy and relatively low adverse event rate for patients with SCI experiencing AD.
Authors: F M Maynard; M B Bracken; G Creasey; J F Ditunno; W H Donovan; T B Ducker; S L Garber; R J Marino; S L Stover; C H Tator; R L Waters; J E Wilberger; W Young Journal: Spinal Cord Date: 1997-05 Impact factor: 2.772
Authors: Ryan Solinsky; Jelena N Svircev; Jennifer J James; Stephen P Burns; Aaron E Bunnell Journal: J Spinal Cord Med Date: 2015-12-14 Impact factor: 1.985
Authors: Andrei Krassioukov; Todd A Linsenmeyer; Lisa A Beck; Stacy Elliott; Peter Gorman; Steven Kirshblum; Lawrence Vogel; Jill Wecht; Sarah Clay Journal: Top Spinal Cord Inj Rehabil Date: 2021
Authors: Sigmund Hough; Colleen Clemency Cordes; Lance L Goetz; Angela Kuemmel; Jesse A Lieberman; Linda R Mona; Mitchell S Tepper; Jithin G Varghese Journal: Top Spinal Cord Inj Rehabil Date: 2020
Authors: Andrei Krassioukov; Todd A Linsenmeyer; Lisa A Beck; Stacy Elliott; Peter Gorman; Steven Kirshblum; Lawrence Vogel; Jill Wecht; Sarah Clay Journal: J Spinal Cord Med Date: 2021-07 Impact factor: 2.040