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Fluid thresholds and outcome from severe brain injury
Guy L Clifton1, Emmy R Miller, Sung C Choi
1Vivian L. Smith Center for Neurologic Research and the Department of Neurosurgery, the University of Texas Medical School at Houston, Houston, TX 77030, USA. guy.l.clifton@uth.tmc.edu
Critical Care Medicine
|April 10, 2002
Summary
Critical thresholds for intracranial pressure, mean arterial pressure, and cerebral perfusion pressure are linked to poor outcomes in severe brain injury. Maintaining adequate mean arterial pressure and avoiding excessive fluid loss are key for better patient results.
Area of Science:
- Neurocritical care
- Trauma surgery
- Intensive care medicine
Background:
- Severe brain injury necessitates meticulous monitoring of hemodynamic and intracranial parameters.
- Understanding critical thresholds is vital for optimizing patient management and improving outcomes.
Purpose of the Study:
- To identify critical thresholds for intracranial pressure (ICP), mean arterial pressure (MAP), cerebral perfusion pressure (CPP), and fluid balance associated with poor outcomes in severe brain injury.
- To analyze the independent and combined effects of these parameters on patient outcomes.
Main Methods:
- Retrospective analysis of data from the National Acute Brain Injury Study: Hypothermia.
- Inclusion of 392 patients (aged 16-65) with severe non-penetrating brain injuries and Glasgow Coma Scale scores of 3-8.
- Monitoring of ICP, MAP, CPP, and fluid balance during the initial 96 hours post-randomization.
Main Results:
- Individually, ICP > 25 mm Hg, MAP < 70 mm Hg, CPP < 60 mm Hg, and fluid balance < -594 mL were associated with increased poor outcomes.
- In a stepwise logistic regression model, admission Glasgow Coma Scale score, age, MAP < 70 mm Hg, fluid balance < -594 mL, and ICP > 25 mm Hg were the strongest predictors of outcome.
- A fluid balance lower than -594 mL showed an independent adverse effect on outcome.
Conclusions:
- Elevated intracranial pressure, low mean arterial pressure, low cerebral perfusion pressure, and negative fluid balance can negatively impact severe brain injury outcomes.
- Fluid balance appears to be an independent predictor of outcome, even when considered alongside other hemodynamic parameters.