Fluid management of the neurological patient: a concise review

Abstract

Maintenance fluids in critically ill brain-injured patients are part of routine critical care. Both the amounts of fluid volumes infused and the type and tonicity of maintenance fluids are relevant in understanding the impact of fluids on the pathophysiology of secondary brain injuries in these patients. In this narrative review, current evidence on routine fluid management of critically ill brain-injured patients and use of haemodynamic monitoring is summarized. Pertinent guidelines and consensus statements on fluid management for brain-injured patients are highlighted. In general, existing guidelines indicate that fluid management in these neurocritical care patients should be targeted at euvolemia using isotonic fluids. A critical appraisal is made of the available literature regarding the appropriate amount of fluids, haemodynamic monitoring and which types of fluids should be administered or avoided and a practical approach to fluid management is elaborated. Although hypovolemia is bound to contribute to secondary brain injury, some more recent data have emerged indicating the potential risks of fluid overload. However, it is acknowledged that many factors govern the relationship between fluid management and cerebral blood flow and oxygenation and more research seems warranted to optimise fluid management and improve outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1309-2) contains supplementary material, which is available to authorized users.

Lessons from the CONSCIOUS-1 Study

“…Ibrahim and colleagues also reported colloid administration and positive fluid balance were associated with poor outcome [ 61 ]. The findings are consistent with conclusions of van der Jagt’s review, three years later, of literature on fluid management of critically-ill brain injured patients [ 63 ]. He concluded that the best hypothesis was that these patients should be kept euvolemic through administration of non-colloid fluids in an attempt to maintain normal physiologic conditions.…”

‘ROSE concept’ of fluid management: Relevance in neuroanaesthesia and neurocritical care

“…Whether this imbalance in fluid management studies between different types of brain injuries is a reflection of differences in clinical relevance of fluid management is not clear. [1] Further randomised controlled trials in the future are essential in SAH and TBI patients who are critical and need long term ICU stay to elucidate and define the role and relevance of the ROSE concept in neuroanaesthesia and neurocritical care.…”

“…The use of hypotonic fluids can lead to tissue oedema, which results in oxygen diffusion and cerebral blood flow (CBF) impairments. [1] Fluid management Journal of Neuroanaesthesiology and Critical Care | Vol. 4 • Issue 1 • Jan-Apr 2017 | fluid balance and fluid overload and the outcomes in critically ill adults.…”

Implementation and Analysis of a Free Water Protocol in Acute Trauma and Stroke Patients

“…Whether hydration changes in the experimental group resulted from intravenous fluid administration or from increased water and ice intake was thus impossible to determine. 21,38 Positive Clinical Outcomes and Negative Clinical Indicators. The research SLP recorded positive and negative clinical outcomes daily during the business week.…”