Fluid Infusion in Postoperative TBI Patients

Traumatic brain injuries are noticed in patients as a severe side effect of surgeries. It can occur because of the events like incisions, retraction, thermal damage, intraoperative hemorrhage and others and can cause several fatal outcomes like nerve damage, paralysis of facial muscles, losing sensations of smell or taste and others. In order to deal with such issues of traumatic brain injury, hypertonic solutions are often used. 

Normal saline (NS) is the most common fluid that is preferred in neurosurgery and neuro intensive care units. The major issue with normal saline is it does not contain all other electrolytes which could be necessary for controlling the situation and may cause hyperchloremic metabolic acidosis if the patient is undergoing prolonged infusion. However, these problems may be addressed in case the patients are provided with balanced fluids that contain all necessary electrolytes making it a more potential physiological isotonic solution that can be infused in patients. 

An experimental study is referred to in detail to understand the comparative changes in electrolyte and acid-base balance between NS and Balanced fluid (Sterofundin ISO) therapy while dealing with postoperative severe traumatic brain injury (TBI) patients in neuro ICU. The study is carried out in 66 severe TBI patients. These patients required a craniectomy or craniotomy on an immediate basis and planning for providing postoperative ventilation care is also done in these cases. Further, to obtain more accurate results regarding the NS (n-33) and Sterofundin ISO (N-33) solutions, they are subjected to a complete assessment of the electrolytic and acid-base parameters at an 8 h interval.

The results indicated that the patients who received NS have showed a significantly lower base (-3.20 versus -1.35, P = 0.049), lower bicarbonate levels (22.03 versus 23.48 mmol/L, P = 0.031) and more hyperchloremia (115.12 versus 111.74 mmol/L, P < 0.001) and hypokalemia (3.36 versus 3.70 mmol/L, P < 0.001) compared to the group of patients who received balanced fluid i.e. Sterofundin ISO group. The patients of the BF group or Sterofundin ISO group are observed to have a significant higher level of calcium (1.97 versus 1.79 mmol/L, P = 0.003) and magnesium (0.94 versus 0.80 mmol/L, P < 0.001) compared to the NS group at a 24 h duration of fluid therapy. In the case of the levels of pH, pCO2 , lactate, and sodium no such significant changes are noted among both the groups. 

Based on the results obtained in the study it can be interpreted that sterofundin ISO can exert potential better effects than NS. The balanced fluid can maintain the parameters of higher electrolytes concentrations and reduce the trend towards hyperchloremic metabolic acidosis compared to the NS therapy when subjected to prolonged fluid therapy in postoperative TBI patients. 

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