Fluid Management in Neurocritical Care

Even though fluid management comprises part of the routine care of critically ill patients, it has profound implications in the neurocritically ill patients. Fluids (type, quantity, and tonicity) have an effect on the state of health and the response to the illness of the injured brain. The injudicious use of fluids in the neurocritical care (NCC) unit leads to complications and secondary injury to the brain in these patients. Various guidelines regarding fluid management in different neurocritical disease states are in use. The overriding principle in almost all guidelines is maintaining euvolemia. Not only is hypovolemia deleterious, but even hypervolemia is dangerous. The factors governing the complex relationship between brain tissue, fluids, and electrolytes and how they are used for the clinical benefit of the patient will ultimately decide the end result.