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Fluid Management in Acute Brain Injury

  • Critical Care (S Mayer, Section Editor)
  • Published:
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Abstract

Purpose of the Review

The aims of fluid management in acute brain injury are to preserve or restore physiology and guarantee appropriate tissue perfusion, avoiding potential iatrogenic effects. We reviewed the literature, focusing on the clinical implications of the selected papers. Our purposes were to summarize the principles regulating the distribution of water between the intracellular, interstitial, and plasma compartments in the normal and the injured brain, and to clarify how these principles could guide fluid administration, with special reference to intracranial pressure control.

Recent Findings

Although a considerable amount of research has been published on this topic and in general on fluid management in acute illness, the quality of the evidence tends to vary. Intravascular volume management should aim for euvolemia. There is evidence of harm with aggressive administration of fluid aimed at achieving hypervolemia in cases of subarachnoid hemorrhage. Isotonic crystalloids should be the preferred agents for volume replacement, while colloids, glucose-containing hypotonic solutions, and other hypotonic solutions or albumin should be avoided. Osmotherapy seems to be effective in intracranial hypertension management; however, there is no clear evidence regarding the superiority of hypertonic saline over mannitol.

Summary

Fluid therapy plays an important role in the management of acute brain injury patients. However, fluids are a double-edged weapon because of the potential risk of hyper-hydration, hypo- or hyper-osmolar conditions, which may unfavorably affect the clinical course and the outcome.

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Authors and Affiliations

  1. Department of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43100, Parma, Italy

    Sandra Rossi & Edoardo Picetti

  2. Neuro ICU, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy

    Tommaso Zoerle, Marco Carbonara & Nino Stocchetti

  3. Department of Neuroscience, Laboratory of Acute Brain Injury and Therapeutic Strategies, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy

    Elisa R Zanier

  4. Department of Physiopathology and Transplantation, Milan University, Milan, Italy

    Nino Stocchetti

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  1. Sandra Rossi
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  2. Edoardo Picetti
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  4. Marco Carbonara
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Correspondence to Sandra Rossi.

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Sandra Rossi, Edoardo Picetti, Tommaso Zoerle, Marco Carbonara, Elisa R Zanier and Nino Stocchetti each declare no potential conflicts of interest.

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Rossi, S., Picetti, E., Zoerle, T. et al. Fluid Management in Acute Brain Injury. Curr Neurol Neurosci Rep 18, 74 (2018). https://doi.org/10.1007/s11910-018-0885-8

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