Prehospital fluids for head injury – keep it simple

January 13, 2012 by  
Filed under All Updates, Resus, Trauma

Just in case you thought you might be missing some recent gem on what we should be giving patients with traumatic brain injury in the field: a team from Melbourne has reviewed the literature and concluded isotonic crystalloids (Ringer’s or Saline) are as good as anything else.


The early management of patients who have sustained traumatic brain injury is aimed at preventing secondary brain injury through avoidance of cerebral hypoxia and hypoperfusion. Especially in hypotensive patients, it has been postulated that hypertonic crystalloids and colloids might support mean arterial pressure more effectively by expanding intravascular volume without causing problematic cerebral oedema. We conducted a systematic review to investigate if hypertonic saline or colloids result in better outcomes than isotonic crystalloid solutions, as well as to determine the safety of minimal volume resuscitation, or delayed versus immediate fluid resuscitation during prehospital care for patients with traumatic brain injury. We identified nine randomized controlled trials and one cohort study examined the effects of hypertonic solutions (with or without colloid added) for prehospital fluid resuscitation. None has reported better survival and functional outcomes over the use of isotonic crystalloids. The only trial of restrictive resuscitation strategies was underpowered to demonstrate its safety compared with aggressive early fluid resuscitation in head injured patients, and maintenance of cerebral perfusion remains the top priority.

Review article: Prehospital fluid management in traumatic brain injury
Emerg Med Australas. 2011 Dec;23(6):665-76

Comments

One Response to “Prehospital fluids for head injury – keep it simple”

  1. Minh Le Cong on January 14th, 2012 21:26

    thanks Cliff. nice review article on the topic. note the advice in regard to using N saline instead of Hartmanns for TBI given the mild differences in osmolality. I also read the review that there are no superior outcomes but also no inferior outcomes. Therefore if I can give lower fluid volumes for the same benefits in terms of treating hypotension and possibly reducing ICP..I consider judicious use of HTS instead of isotonic crystalloids for TBI in the hypotensive TBI patient to be justifiable on the basis of the current evidence…that is similar outcomes and no worsening ! whats your take on that?