Traumatic shock and head injury: effects of fluid resuscitation on the brain.
The effects of resuscitation of traumatic-hemorrhagic shock on the brain are unknown. Traumatic shock in sheep (fracture/crush injury, 2-hr hemorrhage to 40 mm Hg) was followed by resuscitation to baseline mean arterial pressure. Two groups without brain injury were resuscitated with lactated Ringer's (LR1, n = 7) or albumin (ALB1, n = 6). Focal brain injury was added in two further groups (LR2, n = 6; ALB2, n = 6). Hemodynamics, intracranial pressure (ICP), EEG, and colloid osmotic pressure (COP) were followed. Brain water (BW) and cerebral blood volume (CBV) were compared to those of controls (C, n = 7).


RESULTS
ICP rose in all groups. Animals without brain injury did not have increased brain water. Below are results for brain-injured animals after resuscitation (mean +/- SEM). (table; see text) Maintaining COP during initial resuscitation does not minimize cerebral edema: the effects of LR and ALB were similar in this setting. Focal brain injury causes edema but does not cause large increases in ICP with initial resuscitation.
Wisner
D
D
Department of Surgery, University of California, Davis, Sacramento 95817.
Busche
F
F
Sturm
J
J
Gaab
M
M
Meyer
H
H
D000418:Albumins / Q000627:therapeutic use; D000818:Animals; D001810:Blood Volume; D001834:Body Water / Q000378:metabolism; D001921:Brain / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology*; D001930:Brain Injuries / Q000150:complications / Q000473:pathology / Q000503:physiopathology*; D003102:Colloids; D004569:Electroencephalography; D005260:Female; D005440:Fluid Therapy; D006439:Hemodynamics; D007427:Intracranial Pressure; D007552:Isotonic Solutions / Q000627:therapeutic use; D009997:Osmotic Pressure; D000077325:Ringer's Lactate; D012756:Sheep; D012771:Shock, Hemorrhagic / Q000150:complications / Q000628:therapy*; D012774:Shock, Traumatic / Q000150:complications / Q000628:therapy*
D000418:Albumins; D003102:Colloids; D007552:Isotonic Solutions; D000077325:Ringer's Lactate