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Fluid Management in Neurointensive Care

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Textbook of Neuroanesthesia and Neurocritical Care

Abstract

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.

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Competing Interests

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

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Authors and Affiliations

  1. Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland

    Wojciech Dabrowski & Ziemowit Rzecki

  2. Department of Anaesthetics, Critical Care and Pain Management, Pietermaritzburg Metropolitan, Pietermaritzburg, South Africa

    Robert Wise

  3. Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa

    Robert Wise

  4. Intensive Care Unit, University Hospital Brussels (UZB), Jette, Belgium

    Manu L. N. G. Malbrain

  5. Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium

    Manu L. N. G. Malbrain

Authors
  1. Wojciech Dabrowski
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  2. Robert Wise
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  3. Ziemowit Rzecki
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  4. Manu L. N. G. Malbrain
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Editors and Affiliations

  1. Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India

    Hemanshu Prabhakar

  2. Division of Neuroanesthesiology, Department of Anesthesiology, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India

    Zulfiqar Ali

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Dabrowski, W., Wise, R., Rzecki, Z., Malbrain, M.L.N.G. (2019). Fluid Management in Neurointensive Care. In: Prabhakar, H., Ali, Z. (eds) Textbook of Neuroanesthesia and Neurocritical Care. Springer, Singapore. https://doi.org/10.1007/978-981-13-3390-3_2

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  • DOI: https://doi.org/10.1007/978-981-13-3390-3_2

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