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Fluid Management for Neurocritical Care

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Abstract

Fluid management in neurocritically ill patients has an impact on the neurological outcome. The blood-brain barrier (BBB) plays an important role in brain volume regulation, because an intact BBB is only water permeable and electrolyte filtration is strictly regulated. In contrast, BBB disruption leads to impaired autoregulation and induces an increase in transcapillary hydrostatic pressure (P C). Therefore, the control of P C may be an important therapeutic target. In clinical practice, intensivists should pay attention to the fluid osmolality before infusion. In fact, physiological plasma osmolality is 288 ± 5 mOsm/kg, whereas the osmolality of 4% albumin is only 260 mOsm/kg, which represents a hypotonic solution. Infusing such a hypotonic fluid under a disrupted BBB may result in a brain edema. Therefore, albumin administration in patients with acute brain injury should not be recommended routinely. Furthermore, although many investigations and meta-analysis with respect to osmotherapy were published, its beneficial evidence on outcome was not yet shown to be reliable. In both the resuscitation and maintenance phases, the most recommended fluid to be used in neurocritical care is simply the crystalloid. Additionally, hemodynamic monitoring is necessary for patients with acute brain injury, as the volume status is correlated to the neurological outcome. Finally, both the transpulmonary thermodilution and the arterial pulse contour analysis techniques seem feasible to guide fluid management for neurocritical care.

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Authors and Affiliations

  1. Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Tokyo, Japan

    Akira Utagawa

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  1. Akira Utagawa
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Correspondence to Akira Utagawa .

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  1. Department of Acute Medicine, Nihon University School of Medicine , Tokyo, Japan

    Kosaku Kinoshita

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Utagawa, A. (2019). Fluid Management for Neurocritical Care. In: Kinoshita, K. (eds) Neurocritical Care . Springer, Singapore. https://doi.org/10.1007/978-981-13-7272-8_5

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  • DOI: https://doi.org/10.1007/978-981-13-7272-8_5

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