title: An analysis of the relationship between fluid and sodium administration and intracranial pressure after head injury.
abstract: Severe head injury is the leading cause of traumatic death. When a severe head injury is combined with hypotension the mortality doubles. The use of asanguineous salt solutions to maintain blood pressure, however, may contribute to cerebral swelling and intracranial hypertension. For this reason, restrictions of fluids (FLD) and sodium (Na) have been advocated. To our knowledge, however, there are no clinical data to support this recommendation. We hypothesized that in adult patients sustaining severe head injuries (Glasgow Coma Scale score less than or equal to 8) with or without associated injuries: (1) FLD balance and total Na administered during the initial 72 hours of hospital admission are positively and significantly correlated with each other, and (2) total FLD, FLD balance, and total Na administration during the initial 72 hours are significantly and positively correlated with changes in ICP and adverse outcome. We retrospectively studied 40 adult trauma patients with severe head injuries. We found a significant correlation between total Na and FLD balance (R2 = 0.54; p less than 0.05). However, we found no significant correlation between total FLD and maximum ICP (R2 = 0.081), ICP score (R2 = 0.01), or outcome (R2 = 0.066), no significant correlation between FLD balance and maximum ICP (R2 = 0.000), ICP score (R2 = 0.000), or outcome (R2 = 0.01), and no significant correlation between total Na and maximum ICP (R2 = 0.000), ICP score (R2 = 0.001), or outcome (R2 = 0.02). We conclude that Na and FLD administration are not independent determinants of ICP during the initial 72 hours after brain injury.
authors.affiliation: Department of Surgery, College of Medicine, University of Vermont, Burlington.
authors.forename: J D
authors.initials: JD
authors.lastname: Schmoker
authors.forename: S R
authors.initials: SR
authors.lastname: Shackford
authors.forename: S L
authors.initials: SL
authors.lastname: Wald
authors.forename: J A
authors.initials: JA
authors.lastname: Pietropaoli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006259:Craniocerebral Trauma / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D005260:Female; D005440:Fluid Therapy / Q000592:standards*; D015600:Glasgow Coma Scale; D006785:Hospitals, University; D006801:Humans; D015601:Injury Severity Score; D007427:Intracranial Pressure / Q000187:drug effects* / Q000502:physiology; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D012151:Resuscitation / Q000592:standards*; D012964:Sodium / Q000008:administration & dosage / Q000494:pharmacology* / Q000627:therapeutic use; D016896:Treatment Outcome; D014707:Vermont / Q000453:epidemiology; D014882:Water-Electrolyte Balance / Q000187:drug effects* / Q000502:physiology
chemical_list: D012964:Sodium