Fluids and hyperosmolar agents in neurocritical care: an update

Research output: Contribution to journalReview articlepeer-review

Abstract

Purpose of reviewTo discuss recent updates in fluid management and use of hyperosmolar therapy in neurocritical care.Recent findingsMaintaining euvolemia with crystalloids seems to be the recommended fluid resuscitation for neurocritical care patients. Buffered crystalloids have been shown to reduce hyperchloremia in patients with subarachnoid hemorrhage without causing hyponatremia or hypo-osmolality. In addition, in patients with traumatic brain injury, buffered solutions reduce the incidence of hyperchloremic acidosis but are not associated with intracranial pressure (ICP) alteration. Both mannitol and hypertonic saline are established as effective hyperosmolar agents to control ICP. Both agents have been shown to control ICP, but their effects on neurologic outcomes are unclear. A recent surge in preference for using hypertonic saline as a hyperosmolar agent is based on few studies without strong evidence.SummaryFluid resuscitation with crystalloids seems to be reasonable in this setting although no recommendations can be made regarding type of crystalloids. Based on current evidence, elevated ICP can be effectively reduced by either hypertonic saline or mannitol.

Original languageEnglish (US)
Pages (from-to)105-109
Number of pages5
JournalCurrent opinion in critical care
Volume25
Issue number2
DOIs
StatePublished - Apr 1 2019

Keywords

  • fluid
  • hyperosmolar therapy
  • intracranial pressure
  • neurocritical care
  • resuscitation

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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