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The Eastern Association for the Surgery of Trauma (EAST) multicenter cohort of 164 patients with blunt spinal cord injury (SCI) demonstrates that maintaining mean arterial pressure (MAP) ≥85 mm Hg for the first 96 hours failed to increase early American Spinal Injury Association (ASIA) Impairment Scale (AIS) conversion rates despite achieving >80% adherence to protocol targets.1 This finding exposes the potential limitations of uniform vasopressor strategies and aligns with recent critiques highlighting the limited evidence base underlying current MAP recommendations.