title: Review article: Prehospital fluid management in traumatic brain injury.
abstract: The early management of patients who have sustained traumatic brain injury is aimed at preventing secondary brain injury through avoidance of cerebral hypoxia and hypoperfusion. Especially in hypotensive patients, it has been postulated that hypertonic crystalloids and colloids might support mean arterial pressure more effectively by expanding intravascular volume without causing problematic cerebral oedema. We conducted a systematic review to investigate if hypertonic saline or colloids result in better outcomes than isotonic crystalloid solutions, as well as to determine the safety of minimal volume resuscitation, or delayed versus immediate fluid resuscitation during prehospital care for patients with traumatic brain injury. We identified nine randomized controlled trials and one cohort study examined the effects of hypertonic solutions (with or without colloid added) for prehospital fluid resuscitation. None has reported better survival and functional outcomes over the use of isotonic crystalloids. The only trial of restrictive resuscitation strategies was underpowered to demonstrate its safety compared with aggressive early fluid resuscitation in head injured patients, and maintenance of cerebral perfusion remains the top priority.
authors.affiliation: Royal Melbourne Hospital, and Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Pek Ghe
authors.initials: PG
authors.lastname: Tan
authors.forename: Marion
authors.initials: M
authors.lastname: Cincotta
authors.forename: Ornella
authors.initials: O
authors.lastname: Clavisi
authors.forename: Peter
authors.initials: P
authors.lastname: Bragge
authors.forename: Jason
authors.initials: J
authors.lastname: Wasiak
authors.forename: Loyal
authors.initials: L
authors.lastname: Pattuwage
authors.forename: Russell L
authors.initials: RL
authors.lastname: Gruen
mesh_terms: D001930:Brain Injuries / Q000628:therapy*; D003102:Colloids / Q000627:therapeutic use; D004632:Emergency Medical Services; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D006982:Hypertonic Solutions / Q000627:therapeutic use*; D007552:Isotonic Solutions / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012151:Resuscitation
chemical_list: D003102:Colloids; D006982:Hypertonic Solutions; D007552:Isotonic Solutions