Fluid balance and outcome in critically ill patients with traumatic brain injury (CENTER-TBI and OzENTER-TBI): a prospective, multicentre, comparative effectiveness study

SPS commentary:

According to a commentary, until the early 1980s, management of severe traumatic brain injury involved fluid restriction; a practice that accompanied by use of hyperosmolar therapy to treat cerebral oedema, often produced dehydration, which could be severe. Subsequent work identified special concerns with dehydration in patients in this population (reduction in cerebral perfusion pressure by hypotension produces cerebral vasodilation, exacerbating intracranial hypertension). In addition, dehydration also increases the risk of acute renal failure, a complication that adds serious challenges to the management of patients with traumatic brain injury. It notes that these concerns with hypovolaemia and dehydration ushered in an era in which the production of a euvolaemic hyperosmolar state became the target in severe traumatic brain injury, however, over the past decade, the deleterious consequences of fluid overload have been highlighted in studies of acute lung injury and sepsis, including worsened lung function and prolonged duration of mechanical ventilation and ICU stay. It adds that the current study was long overdue, and although the findings are based on observational studies, they suggest the need to meticulously titrate fluid use in patients with severe traumatic brain injury, while avoiding dehydration. It concludes that in critical care, the most beneficial therapies keep coming back into favour, which are optimised within contemporary care. The data from this study echo that message.