Limit Crystalloid Resuscitation after Traumatic Brain Injury

Area of Science:

• Emergency Medicine
• Neurosurgery
• Critical Care

Background:

• Traumatic brain injury (TBI) management often involves fluid resuscitation in the emergency department (ED) to ensure adequate cerebral perfusion.
• The optimal volume of crystalloids for TBI resuscitation remains a critical clinical question.

Purpose of the Study:

• To investigate the association between the volume of crystalloid resuscitation administered in the ED and mortality rates in patients with TBI.
• To determine if higher fluid volumes impact patient outcomes after severe head injury.

Main Methods:

• Retrospective analysis of 875 TBI patients (head AIS score ≥2) treated between 2004 and 2013.
• Patients were categorized into low-volume (<2 L) and high-volume (≥2 L) crystalloid resuscitation groups.
• Multivariable regression analysis was employed to assess mortality odds, controlling for confounding factors.

Main Results:

• The high-volume crystalloid group (15%) exhibited worse baseline characteristics, including lower systolic blood pressure and Glasgow Coma Scale scores, and higher injury severity scores.
• Overall mortality was 12.5%. The high-volume group had significantly higher unadjusted mortality (26% vs. 10%).
• Multivariable analysis revealed that receiving ≥2 L of crystalloids was independently associated with increased odds of mortality (aOR 2.25, P=0.005).

Conclusions:

• Higher volume crystalloid resuscitation in the emergency department is associated with increased mortality in patients with traumatic brain injury.
• These findings suggest that a strategy of limited crystalloid resuscitation may be indicated for TBI patients to improve survival.
• Further prospective studies are warranted to confirm these results and refine resuscitation guidelines for TBI.