Fluid Management in Neurocritical Care

Neurocritical care (NIC) patients require fluids like other critically ill patients, and general principles of fluid management in the critically ill apply to these patients as well. However, special considerations need to be applied to NIC patients because of the nature of their illness, viz. neurological injury causing problems with brain homeostasis. Isotonic crystalloids are the recommended fluids and colloids are generally to be avoided as should be hypo-osmolar fluids. Occasionally, hyperosmolar fluids are required to control raised intracranial pressure. Care must be taken to maintain normovolaemia, which often requires individualised fluid management and multimodal monitoring. Hypovolaemia exacerbates neurological injury and hypervolaemia is detrimental to brain homeostasis. Clinicians should also keep a careful watch on patients’ electrolyte as abnormalities, especially that of sodium, can occur and may/will affect the choice of fluid infused.