open access

Vol 50, No 2 (2018)
Review articles
Published online: 2017-11-22
Submitted: 2017-10-02
Accepted: 2017-11-11
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The use of crystalloids in traumatic brain injury

Wojciech Dąbrowski, Tom Woodcock, Ziemowit Rzecki, Manu L.N.G. Malbrain
DOI: 10.5603/AIT.a2017.0067
·
Pubmed: 29165777
·
Anaesthesiol Intensive Ther 2018;50(2):150-159.

open access

Vol 50, No 2 (2018)
Review articles
Published online: 2017-11-22
Submitted: 2017-10-02
Accepted: 2017-11-11

Abstract

Fluid therapy is one of the most important treatments in patients with traumatic brain injury (TBI) as both hypo- and hypervolaemia can cause harm. The main goals of fluid therapy for patients with TBI are to optimize cerebral perfusion and to maintain adequate cerebral oxygenation. The avoidance of cerebral oedema is clearly essential. The current weight of evidence in the published literature suggests that albumin therapy is harmful and plasma substitutes have failed to demonstrate superiority over crystalloids solutions. Crystalloids are the most common fluids administered in patients with TBI. However, differences in their composition may affect coagulation and plasma tonicity and acid-base homeostasis. The choice of the ideal crystalloid fluid in TBI should be made based on tonicity, type of buffer used and volume status. Hypotonic fluids buffered with substances altering blood coagulation should be avoided in clinical practice. The prescriber remains faced with choices about the tonicity and pH buffering capability of fluid therapy, which we review here.

Abstract

Fluid therapy is one of the most important treatments in patients with traumatic brain injury (TBI) as both hypo- and hypervolaemia can cause harm. The main goals of fluid therapy for patients with TBI are to optimize cerebral perfusion and to maintain adequate cerebral oxygenation. The avoidance of cerebral oedema is clearly essential. The current weight of evidence in the published literature suggests that albumin therapy is harmful and plasma substitutes have failed to demonstrate superiority over crystalloids solutions. Crystalloids are the most common fluids administered in patients with TBI. However, differences in their composition may affect coagulation and plasma tonicity and acid-base homeostasis. The choice of the ideal crystalloid fluid in TBI should be made based on tonicity, type of buffer used and volume status. Hypotonic fluids buffered with substances altering blood coagulation should be avoided in clinical practice. The prescriber remains faced with choices about the tonicity and pH buffering capability of fluid therapy, which we review here.
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Keywords

fluids, intravenous, crystalloids; brain, traumatic injury; fluids, tonicity; blood coagulation; acidosis, hyperchloraemic; cerebral salt wasting; hyponatremia

About this article
Title

The use of crystalloids in traumatic brain injury

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 50, No 2 (2018)

Pages

150-159

Published online

2017-11-22

DOI

10.5603/AIT.a2017.0067

Pubmed

29165777

Bibliographic record

Anaesthesiol Intensive Ther 2018;50(2):150-159.

Keywords

fluids
intravenous
crystalloids
brain
traumatic injury
fluids
tonicity
blood coagulation
acidosis
hyperchloraemic
cerebral salt wasting
hyponatremia

Authors

Wojciech Dąbrowski
Tom Woodcock
Ziemowit Rzecki
Manu L.N.G. Malbrain

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