Fluid Management and Hyperosmolar Therapy in Neurotrauma

Traumatic brain injury (TBI) has unique aspects for consideration in regard to fluid management due to cerebral enclosure in the skull, and properties of ionic diffusion. From necessitating higher target resuscitation blood pressures and selection of fluids in the initial resuscitation to continued use of IV fluids and hypertonic solutions to reduce elevated pressures, traumatic brain injury can add complexity to the management of a trauma patient. Few prospective studies exist to guide management in the TBI patient population, however, here we summarize data to guide the approach to fluid management and hyperosmolar therapy in TBI.