EXPERTS’ OPINION   Free access

Minerva Anestesiologica 2023 October;89(10):936-44

DOI: 10.23736/S0375-9393.23.17328-7

Copyright © 2023 EDIZIONI MINERVA MEDICA

language: English

Fluid therapy in the acute brain injured patient

Saliha ERGEZEN ^{1, 2} ✉, Eveline J. WIEGERS ^{1, 3}, Eva KLIJN ¹, Mathieu van der JAGT ¹

¹ Department of Adults Intensive Care, Erasmus Medical Center, Rotterdam, the Netherlands; ² Department of Neurosurgery, Erasmus Medical Center, Rotterdam, the Netherlands; ³ Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands

Adequate fluid therapy in the acute brain injured (ABI) patient is essential for maintaining an adequate brain and systemic physiology and preventing intra- and extracranial complications. The target of euvolemia, implying avoidance of both hypovolemia and fluid overloading (or “hypervolemia,” by definition associated with fluid extravasation leading to tissue edema) is of key importance. Primary brain injury can be aggravated by secondary brain injury and systemic deterioration through diverse pathways which can challenge appropriate fluid management, e.g. neuroendocrine and electrolyte disorders, stress cardiomyopathy (also known as cardiac stunning) and neurogenic pulmonary edema. This is an updated expert opinion aiming to provide a practical overview on fluid therapy in the ABI patient, partly based on more recent work and stressing the fact that intravenous fluids should be regarded as drugs, with their inherent potential for both benefit and (unintended) harm.

KEY WORDS: Brain injuries; Critical care; Fluid therapy; Hemodynamic monitoring; Blood-brain barrier