Fluid management concepts for severe neurological illness: an overview

Current Opinion in Anaesthesiology
Boris D HeifetsMark A Burbridge

Abstract

The acute care of a patient with severe neurological injury is organized around one relatively straightforward goal: avoid brain ischemia. A coherent strategy for fluid management in these patients has been particularly elusive, and a well considered fluid management strategy is essential for patients with critical neurological illness. In this review, several gaps in our collective knowledge are summarized, including a rigorous definition of volume status that can be practically measured; an understanding of how electrolyte derangements interact with therapy; a measurable endpoint against which we can titrate our patients' fluid balance; and agreement on the composition of fluid we should give in various clinical contexts. As the possibility grows closer that we can monitor the physiological parameters with direct relevance for neurological outcomes and the various complications associated with neurocritical illness, we may finally move away from static therapy recommendations, and toward individualized, precise therapy. Although we believe therapy should ultimately be individualized rather than standardized, it is clear that the monitoring tools and analytical methods used ought to be standardized to facilitate appropriately ...Continue Reading

References

Feb 5, 2000·Stroke; a Journal of Cerebral Circulation·L LennihanR A Solomon
May 28, 2004·The New England Journal of Medicine·Simon FinferUNKNOWN SAFE Study Investigators
Sep 1, 2007·The New England Journal of Medicine·UNKNOWN SAFE Study InvestigatorsShirley Vallance
Sep 13, 2011·Journal of Neurosurgical Anesthesiology·Deepak Sharma, Monica S Vavilala
Jan 19, 2012·Anesthesia and Analgesia·Tomas CorcoranKwok M Ho
Apr 3, 2014·Stroke; a Journal of Cerebral Circulation·Tatsushi MutohTatsuya Ishikawa
Apr 10, 2014·Stroke; a Journal of Cerebral Circulation·Joji B KuramatsuHagen B Huttner
Jan 1, 2014·Journal of Clinical Medicine·Jaime Robenolt GrayDenise H Rhoney
Oct 16, 2015·Anesthesia and Analgesia·Anna Maria BombardieriJohn C Drummond
Jul 28, 2016·Stroke; a Journal of Cerebral Circulation·Renee' H MartinUNKNOWN ALIAS Parts 1 and 2 and NETT Investigators
Sep 16, 2016·Neurocritical Care·Joseph B MillerRobert Welch
Sep 23, 2016·Neurosurgery·Nancy CarneyJamshid Ghajar
Jun 13, 2017·Journal of Intensive Care·Hiroshi Ueyama, Sawami Kiyonaka
Jun 20, 2017·Critical Care : the Official Journal of the Critical Care Forum·Xavier Monnet, Jean-Louis Teboul
Jul 25, 2017·Journal of Critical Care·Claire-Marie DrevetBélaïd Bouhemad
Aug 30, 2017·Acta neurochirurgica·Marek CzosnykaPeter Smielewski
Sep 10, 2017·Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia·Yoichi UozumiEiji Kohmura
Sep 14, 2017·World Neurosurgery·Ramanan RajagopalMathew Joseph
Nov 2, 2017·Neurosurgical Focus·Aditya VedantamShankar P Gopinath
Feb 28, 2018·The New England Journal of Medicine·Matthew W SemlerUNKNOWN SMART Investigators and the Pragmatic Critical Care Research Group
Mar 2, 2018·Acta Neurochirurgica. Supplement·J DonnellyP Smielewski
Mar 22, 2018·Critical Care : the Official Journal of the Critical Care Forum·Victoria A BennettMaurizio Cecconi

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