Is sodium chloride worth its salt?

Area of Science:

• Neurocritical care
• Resuscitation medicine
• Intensive care unit management

Background:

• The optimal fluid for resuscitation in brain-injured patients is debated.
• Hypotonic solutions risk cerebral swelling and intracranial hypertension.
• 0.9% sodium chloride (saline) is traditionally used but has recognized drawbacks.

Purpose of the Study:

• To evaluate the impact of balanced solutions versus 0.9% saline on hyperchloremic acidosis in brain-injured patients.
• To discuss the potential shift from 0.9% saline to more physiological resuscitation fluids.

Main Methods:

• Comparative analysis of fluid resuscitation strategies in brain-injured patients.
• Assessment of electrolyte balance and acid-base status.

Main Results:

• Balanced solutions led to a reduction in hyperchloremic acidosis compared to 0.9% sodium chloride.
• 0.9% saline is associated with adverse acid-base disturbances.

Conclusions:

• Balanced resuscitation fluids may be superior to 0.9% saline for brain-injured patients.
• A move towards physiological solutions is recommended to mitigate complications like acidosis.