Evaluation of the Various Methods of Fluid Resuscitation in Concussion and its Relationship with Patient Outcomes

Document Type : Original Article (s)

Authors

1 Professor, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Student of Medicine, Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Associate Professor, Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Various fluids such as saline, hypertonic saline, and serum colloid are used to compensate the body lost fluids after head trauma. The aim of this study was to determine the effects of various solutions on vital signs, serum electrolytes and acid-base status in patients with head trauma.Methods: This cross-sectional study was done in Alzahra hospital, Isfahan University of Medical Sciences, Iran. 340 hospital records of patients with head trauma were studied and hemodynamic parameters, blood gases and electrolytes were analyzed based on the osmolarity status. The data were analyzed using chi-square and one-way and repeated-measures analysis of variance (ANOVA) tests.Findings: During hospitalization in intensive care unit (ICU), 74 patients (21.8%) died. Need to ventilation was different based on the kind of fluid and the percent of ventilation in hyperosmolar group (48.8%) was lower significantly than the iso- (64.4%) and hypo-osmolar (56.4%) groups (P = 0.042). The mortality rate was significantly higher in iso-osmolar group (37.8%) compared to hypo- (17.9%) and hyperosmolar (15.6%) groups (P < 0.001).Conclusion: Using hyperosmolar solutions in patients with head trauma led to more favorable hemodynamic stability and electrolyte status and lower mortality rates in these patients. So, using hyperosmolar solutions, if there is no contraindication, is preferred to hypo- and iso-smolar solutions and is recommended.

Keywords

References

  1. Tan PG, Cincotta M, Clavisi O, Bragge P, Wasiak J, Pattuwage L, et al. Review article: Prehospital fluid management in traumatic brain injury. Emerg Med Australas 2011; 23(6): 665-76.
  2. Bulger EM, Nathens AB, Rivara FP, Moore M, MacKenzie EJ, Jurkovich GJ. Management of severe head injury: institutional variations in care and effect on outcome. Crit Care Med 2002; 30(8): 1870-6.
  3. Eisenberg HM, Frankowski RF, Contant CF, Marshall LF, Walker MD. High-dose barbiturate control of elevated intracranial pressure in patients with severe head injury. J Neurosurg 1988; 69(1): 15-23.
  4. Knapp JM. Hyperosmolar therapy in the treatment of severe head injury in children: mannitol and hypertonic saline. AACN Clin Issues 2005; 16(2): 199-211.
  5. Jagoda A, Bruns J. Prehospital management of traumatic brain injury. In: Leon-Carrion J, Wild KRH, Zitnay GA, editors. Brain injury treatment: Theories and practices. 1st ed. New York, NY: Taylor and Francis; 2006. p. 1-6.
  6. Lobo DN. Fluid, electrolytes and nutrition: physiological and clinical aspects. Proc Nutr Soc 2004; 63(3): 453-66.
  7. Nguyen MK, Kurtz I. Quantitative interrelationship between Gibbs-Donnan equilibrium, osmolality of body fluid compartments, and plasma water sodium concentration. J Appl Physiol (1985) 2006; 100(4): 1293-300.
  8. Brandstrup B. Fluid therapy for the surgical patient. Best Pract Res Clin Anaesthesiol 2006; 20(2): 265-83.
  9. Zornow MH, Prough DS. Fluid management in patients with traumatic brain injury. New Horiz 1995; 3(3): 488-98.
  10. Haden RL. Therapeutic application of the alteration of brain volumeby the intravenous injection of glucose. JAMA 1919; 73(13): 983-4.
  11. Zhuang J, Shackford SR, Schmoker JD, Pietropaoli JA, Jr. Colloid infusion after brain injury: effect on intracranial pressure, cerebral blood flow, and oxygen delivery. Crit Care Med 1995; 23(1): 140-8.
  12. Walsh JC, Zhuang J, Shackford SR. A comparison of hypertonic to isotonic fluid in the resuscitation of brain injury and hemorrhagic shock. J Surg Res 1991; 50(3): 284-92.
  13. Haddad SH, Arabi YM. Critical care management of severe traumatic brain injury in adults. Scand J Trauma Resusc Emerg Med 2012; 20: 12.
  14. Strandvik GF. Hypertonic saline in critical care: a review of the literature and guidelines for use in hypotensive states and raised intracranial pressure. Anaesthesia 2009; 64(9): 990-1003.
  15. Wenham TN, Hormis AP, Andrzejowski JC. Hypertonic saline after traumatic brain injury in UK neuro-critical care practice. Anaesthesia 2008; 63(5): 558-9.
  16. Dean NP, Boslaugh S, Adelson PD, Pineda JA, Leonard JR. Physician agreement with evidence-based recommendations for the treatment of severe traumatic brain injury in children. J Neurosurg 2007; 107(5 Suppl): 387-91.
  17. Brasel KJ, Bulger E, Cook AJ, Morrison LJ, Newgard CD, Tisherman SA, et al. Hypertonic resuscitation: design and implementation of a prehospital intervention trial. J Am Coll Surg 2008; 206(2): 220-32.
Journal of Isfahan Medical School
Volume 34, Issue 401 - Serial Number 401
September and October 2016
Pages 1160-1167

Files

History

  • Receive Date: 19 July 2016
  • Revise Date: 23 May 2024
  • Accept Date: 06 April 2022

Share

How to cite

Statistics