Инфузионная терапия при остром повреждении головного мозга: обзор литературы

Авторы:

Виталий Александрович Саскин,

Ценципер Л.М.,

Соколова М.М.,

Лочехина Е.Б.,

Всеволод Владимирович Кузьков,

Михаил Юрьевич Киров

Журнал: Анестезиология и реаниматология. 2025;(5):108-119.

DOI: 10.17116/anaesthesiology2025051108

Прочитано: 1550 раз

Резюме

Целями инфузионной терапии при остром повреждении головного мозга (ОПГМ) являются восполнение дефицита объема циркулирующей крови, поддержание центральной гемодинамики, мозгового кровотока, оксигенации, водно-электролитного баланса, а также предупреждение и устранение внутричерепной гипертензии и отека головного мозга.

ЦЕЛЬ ОБЗОРА

Оценить клинические подходы к тактике инфузионной терапии при ОПГМ с учетом механизмов, регулирующих распределение жидкости в головном мозге, в том числе на фоне повышения уровня внутричерепного давления.

ОСНОВНЫЕ ПОЛОЖЕНИЯ

Нами выполнен поиск литературы в медицинских информационных системах PubMed и eLibrary с 2000 по 2024 г. по следующим ключевым словам: острое повреждение головного мозга, инфузионная терапия, кристаллоиды и гиперосмолярная терапия. В настоящем обзоре рассмотрены патофизиологические предпосылки к проведению инфузионной терапии при ОПГМ и современные инфузионные среды. Повреждение гематоэнцефалического барьера ассоциировано с повышением уровня внутричерепного давления и развитием отека мозга. В клинической практике до начала инфузионной нагрузки следует обращать внимание на осмолярность раствора. В ранней фазе ОПГМ предпочтение в большинстве случаев отдается 0,9% раствору NaCl, поскольку его осмолярность несколько выше осмолярности плазмы. Коллоиды, глюкозосодержащие растворы, сбалансированные кристаллоиды с результирующей гипотоничностью, а также альбумин (независимо от концентрации) не рекомендованы для применения на ранней стадии лечения ОПГМ и/или при отсутствии гипернатриемии и гиперхлоремии. В поздней фазе ОПГМ тактика инфузионной терапии является скорее предметом персонализации, нежели стандартизации, так как важную роль в ней играют нейромониторинг и мультимодальный мониторинг центральной гемодинамики.

ЗАКЛЮЧЕНИЕ

При выборе тактики инфузионной терапии необходимо учитывать этиологию и фазу острого повреждения головного мозга, наличие церебральных или экстрацеребральных осложнений, исходный водно-электролитный баланс и его динамические изменения, а также осмолярность плазмы и результирующую тоничность инфузионных сред.

Ключевые слова

острое повреждение головного мозга
инфузионная терапия
кристаллоиды
гиперосмолярная терапия

Дата поступления: 11.03.2025

Дата принятия в печать: 08.04.2025

Дата публикации: 22.10.2025

Литература / References

Orfanakis A, Brambrink AM. Long-term outcome call into question the benefit of positive fluid balance and colloid treatment after aneurysmal subarachnoid hemorrhage. Neurocritical Care. 2013;19(2):137-139. https://doi.org/10.1007/s12028-013-9900-8
Khatib K. Fluid Management in Neurocritical Care. In: Prabhakar H, Singhal V, Zirpe KG, Sapra H, eds. Principles and Practice of Neurocritical Care. Springer, Singapore; 2024. https://doi.org/10.1007/978-981-99-8059-8_36
Интенсивная терапия: национальное руководство: в 2 т. Том 1. Под ред. Заболотских И.Б., Проценко Д.Н. 2-е изд, перераб. и доп. М.: ГЭОТАР-Медиа; 2021.
Van-Der Jagt M. Fluid management of the neurological patient: a concise review. Critical Care. 2016;20(1):126. https://doi.org/10.1186/s13054-016-1309-2
Oddo M, Poole D, Helbok R, Meyfroidt G, Stocchetti N, Bouzat P, Cecconi M, Geeraerts T, Martin-Loeches I, Quintard H, Taccone FS, Geocadin RG, Hemphill C, Ichai C, Menon D, Payen JF, Perner A, Smith M, Suarez J, Videtta W, Zanier ER, Citerio G. Fluid therapy in neurointensive care patients: ESICM consensus and clinical practice recommendations. Intensive Care Medicine. 2018;44(4):449-463. https://doi.org/10.1007/s00134-018-5086-z
Finfer S, Myburgh J, Bellomo R. Intravenous fluid therapy in critically ill adults. Nature Reviews. Nephrology. 2018;14(9):541-557. Erratum in: Nature Reviews. Nephrology. 2018 Nov;14(11):717. https://doi.org/10.1038/s41581-018-0044-0
Hladky SB, Barrand MA. Mechanisms of fluid movement into, through and out of the brain: evaluation of the evidence. Fluids Barriers CNS. 2014;11(1):26. https://doi.org/10.1186/2045-8118-11-26
Rossi S, Picetti E, Zoerle T, Carbonara M, Zanier ER, Stocchetti N. Fluid Management in Acute Brain Injury. Current Neurology and Neuroscience Reports. 2018;18(11):74. https://doi.org/10.1007/s11910-018-0885-8
Qureshi AI, Suarez JI. Use of hypertonic saline solutions in treatment of cerebral edema and intracranial hypertension. Critical Care Medicine. 2000; 28(9):3301-3313. https://doi.org/10.1097/00003246-200009000-00032
Vagnerova K, Rusa R. Fluid management during craniotomy. In: Cottrell JE, Patel P, eds. Neuroanesthesia. Elsevier; 2016:152-165.
Pfau SJ, Langen UH, Fisher TM, Prakash I, Nagpurwala F, Lozoya RA, Lee WA, Wu Z, Gu C. Characteristics of blood-brain barrier heterogeneity between brain regions revealed by profiling vascular and perivascular cells. Nature Neuroscience. 2024;27(10):1892-1903. https://doi.org/10.1038/s41593-024-01743-y
Wilhelm I, Nyúl-Tóth Á, Suciu M, Hermenean A, Krizbai IA. Heterogeneity of the blood-brain barrier. Tissue Barriers. 2016;4(1):e1143544. https://doi.org/10.1080/21688370.2016.1143544
Iliff JJ, Wang M, Liao Y, Plogg BA, Peng W, Gundersen GA, Benveniste H, Vates GE, Deane R, Goldman SA, Nagelhus EA, Nedergaard M. A paravascular pathway facilitates CSF flow through the brain parenchyma and the clearance of interstitial solutes, including amyloid β. Science Translational Medicine. 2012;4(147):147ra111. https://doi.org/10.1126/scitranslmed.3003748
Sun BL, Wang LH, Yang T, Sun JY, Mao LL, Yang MF, Yuan H, Colvin RA, Yang XY. Lymphatic drainage system of the brain: A novel target for intervention of neurological diseases. Progress in Neurobiology. 2018;163-164:118-143. https://doi.org/10.1016/j.pneurobio.2017.08.007
Ergezen S, Wiegers EJ, Klijn E, van der Jagt M. Fluid therapy in the acute brain injured patient. Minerva Anestesiologica. 2023;89(10):936-944. https://doi.org/10.23736/S0375-9393.23.17328-7
Stokum JA, Gerzanich V, Simard JM. Molecular pathophysiology of cerebral edema. Journal of Cerebral Blood Flow and Metabolism. 2016;36(3):513-538. https://doi.org/10.1177/0271678X15617172
Malbrain MLNG, Van Regenmortel N, Saugel B, De Tavernier B, Van Gaal PJ, Joannes-Boyau O, Teboul JL, Rice TW, Mythen M, Monnet X. Principles of fluid management and stewardship in septic shock: it is time to consider the four D’s and the four phases of fluid therapy. Annals of Intensive Care. 2018;8(1):66. https://doi.org/10.1186/s13613-018-0402-x
McHugh GS, Engel DC, Butcher I, Steyerberg EW, Lu J, Mushkudiani N, Hernández AV, Marmarou A, Maas AI, Murray GD. Prognostic value of secondary insults in traumatic brain injury: results from the IMPACT study. Journal of Neurotrauma. 2007;24(2):287-93. https://doi.org/10.1089/neu.2006.0031
Güiza F, Meyfroidt G, Piper I, Citerio G, Chambers I, Enblad P, Nillson P, Feyen B, Jorens P, Maas A, Schuhmann MU, Donald R, Moss L, Van den Berghe G, Depreitere B. Cerebral Perfusion Pressure Insults and Associations with Outcome in Adult Traumatic Brain Injury. Journal of Neurotrauma. 2017;34(16):2425-2431. https://doi.org/10.1089/neu.2016.4807
Esteban-Zubero E, García-Muro C, Alatorre-Jiménez MA. Fluid therapy and traumatic brain injury: A narrative review. Medicina Clinica. 2023;161(1):27-32. https://doi.org/10.1016/j.medcli.2023.03.003
Maas AIR, Menon DK, Adelson PD, Andelic N, Bell MJ, Belli A, Bragge P, Brazinova A, Büki A, Chesnut RM, Citerio G, Coburn M, Cooper DJ, Crowder AT, Czeiter E, Czosnyka M, Diaz-Arrastia R, Dreier JP, Duhaime AC, Ercole A, van Essen TA, Feigin VL, Gao G, Giacino J, Gonzalez-Lara LE, Gruen RL, Gupta D, Hartings JA, Hill S, Jiang JY, Ketharanathan N, Kompanje EJO, Lanyon L, Laureys S, Lecky F, Levin H, Lingsma HF, Maegele M, Majdan M, Manley G, Marsteller J, Mascia L, McFadyen C, Mondello S, Newcombe V, Palotie A, Parizel PM, Peul W, Piercy J, Polinder S, Puybasset L, Rasmussen TE, Rossaint R, Smielewski P, Söderberg J, Stanworth SJ, Stein MB, von Steinbüchel N, Stewart W, Steyerberg EW, Stocchetti N, Synnot A, Te Ao B, Tenovuo O, Theadom A, Tibboel D, Videtta W, Wang KKW, Williams WH, Wilson L, Yaffe K; InTBIR Participants and Investigators. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurologyogy. 2017;16(12):987-1048. https://doi.org/10.1016/S1474-4422(17)30371-X
Ginsberg MD, Palesch YY, Hill MD, Martin RH, Moy CS, Barsan WG, Waldman BD, Tamariz D, Ryckborst KJ; ALIAS and Neurological Emergencies Treatment Trials (NETT) Investigators. High-dose albumin treatment for acute ischaemic stroke (ALIAS) Part 2: a randomised, double-blind, phase 3, placebo-controlled trial. Lancet Neurology. 2013;12(11):1049-1058. https://doi.org/10.1016/S1474-4422(13)70223-0
Palesch YY, Hill MD, Ryckborst KJ, Tamariz D, Ginsberg MD. The ALIAS Pilot Trial: a dose-escalation and safety study of albumin therapy for acute ischemic stroke-II: neurologic outcome and efficacy analysis. Stroke. 2006;37(8):2107-2114. https://doi.org/10.1161/01.STR.0000231389.34701.b5
Suarez JI, Shannon L, Zaidat OO, Suri MF, Singh G, Lynch G, Selman WR. Effect of human albumin administration on clinical outcome and hospital cost in patients with subarachnoid hemorrhage. Journal of Neurosurgery. 2004;100(4):585-590. https://doi.org/10.3171/jns.2004.100.4.0585
SAFE Study Investigators; Australian and New Zealand Intensive Care Society Clinical Trials Group; Australian Red Cross Blood Service; George Institute for International Health; Myburgh J, Cooper DJ, Finfer S, Bellomo R, Norton R, Bishop N, Kai Lo S, Vallance S. Saline or albumin for fluid resuscitation in patients with traumatic brain injury. New England Journal of Medicine. 2007;357(9):874-884. https://doi.org/10.1056/NEJMoa067514
Ibrahim GM, Macdonald RL. The effects of fluid balance and colloid administration on outcomes in patients with aneurysmal subarachnoid hemorrhage: a propensity score-matched analysis. Neurocritical Care. 2013;19(2): 140-149. https://doi.org/10.1007/s12028-013-9860-z
Tseng MY, Hutchinson PJ, Kirkpatrick PJ. Effects of fluid therapy following aneurysmal subarachnoid haemorrhage: a prospective clinical study. British Journal of Neurosurgery. 2008;22(2):257-268. https://doi.org/10.1080/02688690701832100
Sekhon MS, Dhingra VK, Sekhon IS, Henderson WR, McLean N, Griesdale DE. The safety of synthetic colloid in critically ill patients with severe traumatic brain injuries. Journal of Critical Care. 2011;26(4):357-362. https://doi.org/10.1016/j.jcrc.2010.12.001
Lehmann L, Bendel S, Uehlinger DE, Takala J, Schafer M, Reinert M, Jakob SM. Randomized, double-blind trial of the effect of fluid composition on electrolyte, acid-base, and fluid homeostasis in patients early after subarachnoid hemorrhage. Neurocritical Care. 2013;18(1):5-12. https://doi.org/10.1007/s12028-012-9764-3
Roquilly A, Loutrel O, Cinotti R, Rosenczweig E, Flet L, Mahe PJ, Dumont R, Marie Chupin A, Peneau C, Lejus C, Blanloeil Y, Volteau C, Asehnoune K. Balanced versus chloride-rich solutions for fluid resuscitation in brain-injured patients: a randomised double-blind pilot study. Critical Care. 2013;17(2):R77. https://doi.org/10.1186/cc12686
Попугаев К. А, Савин И.А., Курдюмова Н.В., Лукьянов В.И. Опыт применения растворов Нормофундин и Стерофундин для коррекции гипернатриемии. Анестезиология и реаниматология. 2009;(5):39-41.
Горбатых С.В., Павлова Е.В., Лившиц М.И., Попов В.Е, Воронюк Г.М. Опыт применения раствора «Стерофундин изотонический» в комплексной терапии у тяжелобольных детей с нейрохирургической патологией. Вестник интенсивной терапии имени А.И. Салтанова. 2010;3:50-58.
Dong WH, Yan WQ, Song X, Zhou WQ, Chen Z. Fluid resuscitation with balanced crystalloids versus normal saline in critically ill patients: a systematic review and meta-analysis. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2022;30(1):28. https://doi.org/10.1186/s13049-022-01015-3
Lombardo S, Smith MC, Semler MW, Wang L, Dear ML, Lindsell CJ, Freundlich RE, Guillamondegui OD, Self WH, Rice TW; Isotonic Solutions and Major Adverse Renal Events Trial (SMART) Investigators and Vanderbilt Learning Healthcare System Platform Investigators. Balanced Crystalloid versus Saline in Adults with Traumatic Brain Injury: Secondary Analysis of a Clinical Trial. Journal of Neurotrauma. 2022;39(17-18):1159-1167. https://doi.org/10.1089/neu.2021.0465
Poh K, Bustam A, Hasan MS, Mohd Yunos N, Cham CY, Lim FJ, Ahmad Zahedi AZ, Zambri A, Noor Azhar M. Isotonic balanced fluid versus 0.9% saline in patients with moderate to severe traumatic brain injury: A double-blinded randomised controlled trial. American Journal of Emergency Medicine. 2024;77:106-114. https://doi.org/10.1016/j.ajem.2023.11.064
Zampieri FG, Cavalcanti AB, Di Tanna GL, Damiani LP, Hammond NE, Machado FR, Micallef S, Myburgh J, Ramanan M, Venkatesh B, Rice TW, Semler MW, Young PJ, Finfer S. Balanced crystalloids versus saline for critically ill patients (BEST-Living): a systematic review and individual patient data meta-analysis. Lancet Respiratory Medicine. 2024;12(3):237-246. https://doi.org/10.1016/S2213-2600(23)00417-4
Cooper DJ, Myles PS, McDermott FT, Murray LJ, Laidlaw J, Cooper G, Tremayne AB, Bernard SS, Ponsford J; HTS Study Investigators. Prehospital hypertonic saline resuscitation of patients with hypotension and severe traumatic brain injury: a randomized controlled trial. JAMA. 2004;291(11):1350-1357. https://doi.org/10.1001/jama.291.11.1350
Baker AJ, Rhind SG, Morrison LJ, Black S, Crnko NT, Shek PN, Rizoli SB. Resuscitation with hypertonic saline-dextran reduces serum biomarker levels and correlates with outcome in severe traumatic brain injury patients. Journal of Neurotrauma. 2009;26(8):1227-1240. https://doi.org/10.1089/neu.2008.0868
Shackford SR, Bourguignon PR, Wald SL, Rogers FB, Osler TM, Clark DE. Hypertonic saline resuscitation of patients with head injury: a prospective, randomized clinical trial. Journal of Trauma. 1998;44(1):50-58. https://doi.org/10.1097/00005373-199801000-00004
Cook AM, Morgan Jones G, Hawryluk GWJ, Mailloux P, McLaughlin D, Papangelou A, Samuel S, Tokumaru S, Venkatasubramanian C, Zacko C, Zimmermann LL, Hirsch K, Shutter L. Guidelines for the Acute Treatment of Cerebral Edema in Neurocritical Care Patients. Neurocritical Care. 2020;32(3):647-666. https://doi.org/10.1007/s12028-020-00959-7
Ichai C, Payen JF, Orban JC, Quintard H, Roth H, Legrand R, Francony G, Leverve XM. Half-molar sodium lactate infusion to prevent intracranial hypertensive episodes in severe traumatic brain injured patients: a randomized controlled trial. Intensive Care Medicine. 2013;39(8):1413-1422. https://doi.org/10.1007/s00134-013-2978-9
Schwarz S, Schwab S, Bertram M, Aschoff A, Hacke W. Effects of hypertonic saline hydroxyethyl starch solution and mannitol in patients with increased intracranial pressure after stroke. Stroke. 1998;29(8):1550-1555. https://doi.org/10.1161/01.str.29.8.1550
Ware ML, Nemani VM, Meeker M, Lee C, Morabito DJ, Manley GT. Effects of 23.4% sodium chloride solution in reducing intracranial pressure in patients with traumatic brain injury: a preliminary study. Neurosurgery. 2005;57(4):727-736; discussion 727-736.
Mangat HS, Chiu YL, Gerber LM, Alimi M, Ghajar J, Härtl R. Hypertonic saline reduces cumulative and daily intracranial pressure burdens after severe traumatic brain injury. Journal of Neurosurgery. 2015;122(1):202-210. https://doi.org/10.3171/2014.10.JNS132545
Misra UK, Kalita J, Vajpayee A, Phadke RV, Hadique A, Savlani V. Effect of single mannitol bolus in intracerebral hemorrhage. European Journal of Neurology. 2007;14(10):1118-1123. https://doi.org/10.1111/j.1468-1331.2007.01918.x
Diringer MN, Scalfani MT, Zazulia AR, Videen TO, Dhar R. Cerebral hemodynamic and metabolic effects of equi-osmolar doses mannitol and 23.4% saline in patients with edema following large ischemic stroke. Neurocritical Care. 2011;14(1):11-17. https://doi.org/10.1007/s12028-010-9465-8
Ye H, Su Y. Hemodynamic effects of mannitol infusion in patients with acute intracerebral hemorrhage. Acta Cirurgica Brasileira. 2013; 28(2):106-111. https://doi.org/10.1590/s0102-86502013000200004
Cottenceau V, Masson F, Mahamid E, Petit L, Shik V, Sztark F, Zaaroor M, Soustiel JF. Comparison of effects of equiosmolar doses of mannitol and hypertonic saline on cerebral blood flow and metabolism in traumatic brain injury. Journal of Neurotrauma. 2011;28(10):2003-2012. https://doi.org/10.1089/neu.2011.1929
Asehnoune K, Lasocki S, Seguin P, Geeraerts T, Perrigault PF, Dahyot-Fizelier C, Paugam Burtz C, Cook F, Demeure Dit Latte D, Cinotti R, Mahe PJ, Fortuit C, Pirracchio R, Feuillet F, Sébille V, Roquilly A; ATLANREA group; COBI group. Association between continuous hyperosmolar therapy and survival in patients with traumatic brain injury — a multicentre prospective cohort study and systematic review. Critical Care. 2017;21(1):328. https://doi.org/10.1186/s13054-017-1918-4
Wang X, Arima H, Yang J, Zhang S, Wu G, Woodward M, Muñoz-Venturelli P, Lavados PM, Stapf C, Robinson T, Heeley E, Delcourt C, Lindley RI, Parsons M, Chalmers J, Anderson CS; INTERACT2 Investigators. Mannitol and Outcome in Intracerebral Hemorrhage: Propensity Score and Multivariable Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial 2 Results. Stroke. 2015;46(10):2762-2767. https://doi.org/10.1161/STROKEAHA.115.009357
Bereczki D, Mihálka L, Szatmári S, Fekete K, Di Cesar D, Fülesdi B, Csiba L, Fekete I. Mannitol use in acute stroke: case fatality at 30 days and 1 year. Stroke. 2003;34(7):1730-1735. https://doi.org/10.1161/01.STR.0000078658.52316.E8
Egge A, Waterloo K, Sjøholm H, Solberg T, Ingebrigtsen T, Romner B. Prophylactic hyperdynamic postoperative fluid therapy after aneurysmal subarachnoid hemorrhage: a clinical, prospective, randomized, controlled study. Neurosurgery. 2001;49(3):593-605; discussion 605-6. https://doi.org/10.1097/00006123-200109000-00012
Kissoon NR, Mandrekar JN, Fugate JE, Lanzino G, Wijdicks EF, Rabinstein AA. Positive Fluid Balance Is Associated with Poor Outcomes in Subarachnoid Hemorrhage. Journal of Stroke and Cerebrovascular Diseases. 2015;24(10):2245-2251. https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.05.027
Lennihan L, Mayer SA, Fink ME, Beckford A, Paik MC, Zhang H, Wu YC, Klebanoff LM, Raps EC, Solomon RA. Effect of hypervolemic therapy on cerebral blood flow after subarachnoid hemorrhage: a randomized controlled trial. Stroke. 2000;31(2):383-391. https://doi.org/10.1161/01.str.31.2.383
Muench E, Horn P, Bauhuf C, Roth H, Philipps M, Hermann P, Quintel M, Schmiedek P, Vajkoczy P. Effects of hypervolemia and hypertension on regional cerebral blood flow, intracranial pressure, and brain tissue oxygenation after subarachnoid hemorrhage. Critical Care Medicine. 2007;35(8):1844-1851; quiz 1852. https://doi.org/10.1097/01.CCM.0000275392.08410.DD
Shimoda M, Oda S, Tsugane R, Sato O. Intracranial complications of hypervolemic therapy in patients with a delayed ischemic deficit attributed to vasospasm. Journal of Neurosurgery. 1993;78(3):423-429. https://doi.org/10.3171/jns.1993.78.3.0423
Mutoh T, Kazumata K, Terasaka S, Taki Y, Suzuki A, Ishikawa T. Early intensive versus minimally invasive approach to postoperative hemodynamic management after subarachnoid hemorrhage. Stroke. 2014;45(5):1280-1284. https://doi.org/10.1161/STROKEAHA.114.004739
Kurtz P, Helbok R, Ko SB, Claassen J, Schmidt JM, Fernandez L, Stuart RM, Connolly ES, Badjatia N, Mayer SA, Lee K. Fluid responsiveness and brain tissue oxygen augmentation after subarachnoid hemorrhage. Neurocritical Care. 2014;20(2):247-254. https://doi.org/10.1007/s12028-013-9910-6
Tagami T, Kuwamoto K, Watanabe A, Unemoto K, Yokobori S, Matsumoto G, Yokota H; SAH PiCCO Study Group. Optimal range of global end-diastolic volume for fluid management after aneurysmal subarachnoid hemorrhage: a multicenter prospective cohort study. Critical Care Medicine. 2014;42(6):1348-1356. https://doi.org/10.1097/CCM.0000000000000163
Yoneda H, Nakamura T, Shirao S, Tanaka N, Ishihara H, Suehiro E, Koizumi H, Isotani E, Suzuki M; SAH PiCCO Study Group. Multicenter prospective cohort study on volume management after subarachnoid hemorrhage: hemodynamic changes according to severity of subarachnoid hemorrhage and cerebral vasospasm. Stroke. 2013;44(8):2155-2161. https://doi.org/10.1161/STROKEAHA.113.001015
Wiegers EJA, Lingsma HF, Huijben JA, Cooper DJ, Citerio G, Frisvold S, Helbok R, Maas AIR, Menon DK, Moore EM, Stocchetti N, Dippel DW, Steyerberg EW, van der Jagt M; CENTER-TBI; OzENTER-TBI Collaboration Groups. Fluid balance and outcome in critically ill patients with traumatic brain injury (CENTER-TBI and OzENTER-TBI): a prospective, multicentre, comparative effectiveness study. Lancet Neurology. 2021;20(8):627-638. https://doi.org/10.1016/S1474-4422(21)00162-9