Fluid Resuscitation of Brain Injury and Shock: Preventing Secondary Injury

  • S. R. Shackford
Conference paper


Head injury remains the leading cause of traumatic death. Secondary insults, such as hypoxia or hypotension, occur in up to one-third of head-injured patients. When secondary insults occur they increase the incidence of adverse outcome. Of the two insults, hypoxia or hypertension, hypotension appears to have the greatest impact upon outcome. Because hypotension has such a disastrous effect on outcome, it is apparent that hypovolemia must be treated aggressively in patients with head injury.

There are currently no methodologies available to determine the presence of secondary injury in patients who have suffered head trauma. Surrogates, such as ICP, CBF and cortical water content are currently felt to be adequate indicators of secondary injury.

Laboratory and clinical evidence would suggest that administration of solute “free” water to head-injured patients increases the ICP, decreases intracranial compliance and increases cortical water content. Hypertonic solutions appear to decrease ICP, improve intracranial compliance and maintain or elevate CBF. Hemoglobin substitutes are currently under evaluation.


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