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Saskin V.A.

Northern State Medical University

Tsentsiper L.M.

Almazov National Medical Research Center

Sokolova M.M.

Northern State Medical University

Lochekhina E.B.

Northern State Medical University

Kuzkov V.V.

Northern State Medical University

Kirov M.Yu.

Northern State Medical University

Fluid therapy for acute brain injury

Authors:

Saskin V.A., Tsentsiper L.M., Sokolova M.M., Lochekhina E.B., Kuzkov V.V., Kirov M.Yu.

More about the authors

Journal: Russian Journal of Anesthesiology and Reanimatology. 2025;(5): 108‑119

DOI: 10.17116/anaesthesiology2025051108

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Table of contents

FLUID THERAPY FOR ACUTE BRAIN INJURY
FLUID THERAPY FOR ACUTE BRAIN INJURY

To cite this article:

Saskin VA, Tsentsiper LM, Sokolova MM, Lochekhina EB, Kuzkov VV, Kirov MYu. Fluid therapy for acute brain injury. Russian Journal of Anesthesiology and Reanimatology. 2025;(5):108‑119. (In Russ.)
https://doi.org/10.17116/anaesthesiology2025051108

МСФ на ЯМ
Использование инфографики авторами научных работ
Recommended articles:
Effect of infu­sion therapy volume on the first day after gastropancreatoduodenal rese­ction on imme­diate outcomes. Russian Journal of Anesthesiology and Reanimatology. 2025;(2):13-19
Abstract:

BACKGROUND

The primary goals of fluid therapy in acute brain injury (ABI) are recovery of circulating blood volume, maintaining central hemodynamics, cerebral blood flow, oxygenation, and water-electrolyte balance, as well as prevention and treatment of intracranial hypertension and cerebral edema.

OBJECTIVE

To evaluate clinical approaches to fluid therapy in ABI taking into account the mechanisms regulating cerebral fluid distribution.

MATERIAL AND METHODS

We reviewed the PubMed and eLibrary databases between 2000 and 2024 using the following keywords: acute brain injury, fluid therapy, crystalloids, and hyperosmolar therapy. This review explores pathophysiological basis of fluid therapy in ABI and modern infusion solutions. Damage to blood-brain barrier (BBB) is associated with increased intracranial pressure (ICP) and cerebral edema. In clinical practice, osmolarity of intravenous solution should be considered before infusion. In early phase of ABI treatment, 0.9% NaCl is preferable in most cases as its osmolarity is slightly higher than one of blood plasma. Colloids, glucose-containing hypotonic solutions, balanced crystalloids, and albumin (regardless of concentration) are not recommended at this stage, particularly in the absence of hypernatremia or hyperchloremia. In delayed phase, fluid therapy should be personalized rather than standardized, while neuromonitoring and multimodal central hemodynamic monitoring are essential.

CONCLUSION

When choosing fluid therapy, one should consider etiology and phase of brain injury, cerebral or extracerebral complications, baseline water-electrolyte balance and its dynamics, plasma osmolarity, and tonicity of solutions.

Keywords:

acute brain injury
infusion therapy
crystalloids
hyperosmolar therapy

Authors:

Saskin V.A.

Northern State Medical University

Tsentsiper L.M.

Almazov National Medical Research Center

Sokolova M.M.

Northern State Medical University

Lochekhina E.B.

Northern State Medical University

Kuzkov V.V.

Northern State Medical University

Kirov M.Yu.

Northern State Medical University

Received:

11.03.2025

Accepted:

08.04.2025

Close metadata

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