Traumatic Brain Injury-A Review of Intravenous Fluid Therapy

Abstract

This manuscript will review intravenous fluid therapy in traumatic brain injury. Both human and animal literature will be included. Basic treatment recommendations will also be discussed.

Keywords: TBI; colloid; crystalloid; fluid therapies; hypertonic saline; mannitol; osmotherapy; traumatic brain injury.

Figure 1

Fluid therapy for the TBI patient. *Fluid resuscitation techniques can be any one of the following or a combination thereof: (1) 10–20 ml/kg crystalloids (Plasma Lyte or Normosol-R) IV rapid infusion up to 60–90 ml/kg. (2) 5–10 ml/kg 6% HES (tetrastarch) IV rapid infusion up to 40–50 ml/kg. (3) 5–10 ml/kg plasma rapid infusion IV up to 20–30 ml/kg. (4) 3–4 ml/kg 7% HTS IV over 10–15 min. (5) whole blood or pRBC, if indicated. **Altered level of consciousness with or without bilateral or unilateral miotic pupils; unresponsive mid range pupil(s) or mydriasis; loss of the oculocephalic reflex; bradycardia with hypertension (Cushing reflex); posturing (opisthotonus, decerebellate, decerebrate); alteration of the respiratory pattern. ***1 g/kg mannitol IV up to 3 doses q60–90 min OR 3–4 ml/kg 7% HTS IV.