Fluid Management in Neurointensive Care

  • Wojciech Dabrowski
  • Robert Wise
  • Ziemowit Rzecki
  • Manu L. N. G. Malbrain


The main treatment for intravascular volume deficit is the appropriate administration of intravenous fluids, taking into account the type, timing, dose and frequency of dosages. According to the revised Starling equation, the inappropriate administration of intravenous fluid may cause pathological interstitial fluid distribution and elimination. This may adversely affect perivascular fluid balance and brain interstitial fluid composition, finally leading to cerebral and/or spinal cord oedema and cellular injury. Fluid composition and tonicity are crucial when considering which intravenous solution to use in the treatment of neurologic conditions, particularly cerebral trauma. This chapter discusses the different choices of fluid treatment in neurointensive care patients. This decision-making process should be guided by the patient’s haemodynamic condition, electrolyte disturbances and type and phase of the central nervous system injury. Generally, hypotonic fluids and synthetic colloids should be avoided. Both cumulative negative and positive fluid balance within the first week are associated with worse outcomes. The use of saline solutions should be guided by serum electrolyte concentrations.


Neurointensive care Critical care Fluids Intravenous Neurosurgery Trauma 


Competing Interests

Wojciech Dabrowski, Robert Wise, Tom Woodcock, Ziemowit Rzecki and Manu Malbrain declare that they have no competing interests.


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Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Wojciech Dabrowski
    • 1
  • Robert Wise
    • 2
    • 3
  • Ziemowit Rzecki
    • 1
  • Manu L. N. G. Malbrain
    • 4
    • 5
  1. 1.Department of Anaesthesiology and Intensive TherapyMedical University of LublinLublinPoland
  2. 2.Department of Anaesthetics, Critical Care and Pain ManagementPietermaritzburg MetropolitanPietermaritzburgSouth Africa
  3. 3.Discipline of Anaesthesiology and Critical Care, School of Clinical MedicineUniversity of KwaZulu-NatalDurbanSouth Africa
  4. 4.Intensive Care UnitUniversity Hospital Brussels (UZB)JetteBelgium
  5. 5.Faculty of Medicine and PharmacyVrije Universiteit Brussel (VUB)BrusselsBelgium

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