Fluid Haemodynamics in Patients with Severe TBI
The support for saline or other crystalloid solutions as the main plasma volume expanders in TBI patients is supported by the results of the SAFE-TBI study. This fluid regimen is cheaper than other fluid regimens using albumin or synthetic colloids. A crystalloid solution is distributed throughout the whole of the extracellular space of the body, which means that only 20–25% of the volume infused will stay intravascularly and the rest will be relatively quickly distributed to the interstitial space of the body. The maintenance of normovolemia with saline or other crystalloids therefore means the need for large volumes, resulting in interstitial oedema with potential side effects in terms of increased lung water, greater diffusion distances, and an increased risk of compartment syndrome. What may be more important in the TBI patient is that distribution of crystalloids will occur also to the brain interstitium, provided the blood–brain barrier (BBB) has become permeable for small solutes. There is apparently a risk that the use of saline will trigger the development of tissue oedema not only in organs away from the brain but also in the brain itself in TBI patients (Grände 2006; Jungner et al. 2010). Large volumes of saline may also induce adverse hyperchloraemic acidosis. Albumin, the most common colloid used in TBI patients, exerts a more sustained plasma volume expansion. It is not degraded, and in large volumes it have the disadvantage to accumulate in various tissues of the body. Albumin will help to maintain a normal plasma oncotic pressure, which may limit a vasogenic brain oedema.
KeywordsPlasma Volume Expander Synthetic Colloid Erythrocyte Transfusion Transcapillary Escape Rate Plasma Oncotic Pressure
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