Analytic Reviews : Fluid Resuscitation in Head Injury

Abstract

Head injury, either alone or in combination with hy povolemic shock, is the leading cause of traumatic death in this country. Factors contributing to mortality in clude the primary impact injury as well as subsequent ischemia and hypoperfusion. Intravenous fluid therapy is required in all of these patients. However, fluid ther apy may increase brain swelling and cerebral edema formation which could lead to an increase in intracra nial pressure and a reduction in cerebral perfusion pres sure. The use of standard fluid therapy has been ques tioned, and novel therapies involving hyperosmolar and hypertonic solutions are now being investigated. This review covers recent advances in the understanding of the effects of fluid resuscitation on the brain. It also includes a brief summary of the determinants of trans- capillary fluid exchange and a review of relevant cere bral circulatory physiology and the physiological aberra tions produced by brain injury.