The Relationship of Fluid Balance and Sodium Administration to Cerebral Edema Formation and Intracranial Pressure in a Porcine Model of Brain Injury

Fluid Balance, Complications, and Brain Tissue Oxygen Tension Monitoring Following Severe Traumatic Brain Injury

“…Whether a similar phenomenon occurs in the brain, particularly when the blood brain barrier has been disrupted, remains uncertain. Some animal experiments have supported this paradigm, but is has not been convincingly confirmed in human studies [8,9,15,31,32]. In our cohort of consecutive patients with severe TBI, we could not detect any association between cumulative fluid balance and the development of RIH.…”

“…Thirty-three patients were subsequently excluded from the analysis for the following reasons: improvement in GCS to greater than 8 within 24 h (13); age (8); death within 24 h (4); RIH within 24 h (3); withdrawal of care (4); and incomplete medical records (1). The majority of patients were Caucasian (80%), male (73%) and suffered blunt head trauma (95%).…”

“…Careful avoidance of a positive fluid balance, with concomitant administration of albumin to ensure that colloid osmotic pressure and intravascular volume are preserved, has been popularized as one component of the ''Lund Concept'' for the management of patients with severe TBI [1,[3][4][5][6][7][8].…”

Continuous Renal Replacement Therapy for Refractory Intracranial Hypertension

“…Limited data, mostly from late 1960s through mid 1980s, lend some support to this theory [9,10] although more recent data suggest the opposite [11][12][13]. Hypovolemia from underresuscitation is known to exacerbate secondary brain injury.…”

Intensive Care Management of Acute Ischemic Stroke

“…More hypotonic formulations, such as 0.45% saline and Lactated Ringer solution, are almost never used, because they do not augment or maintain intravascular volume as well as normal saline and, by virtue of their lower osmolality, can worsen cerebral edema. 108,109 While intermittent bolus administration of hypertonic saline solutions such as 3% saline can be useful for treating intracranial hypertension, their value as a continuous infusion is unclear. 110,111 The authors reserve continuous infusions of hypertonic saline for the treatment of severe hyponatremia.…”