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Colloid infusion after brain injury: effect on intracranial pressure, cerebral blood flow, and oxygen delivery
J Zhuang1, S R Shackford, J D Schmoker
1Department of Surgery, College of Medicine, University of Vermont, Burlington.
Objectives:
We sought to determine the effects of colloid osmotic pressure on cerebral edema formation after brain injury. We hypothesized that an increase in plasma oncotic pressure accompanying a colloid infusion would be associated with a decrease in intracranial pressure and increases in cerebral blood flow and oxygen delivery when compared with isotonic crystalloid.
Design:
Prospective, laboratory study.
Setting:
University surgical research laboratory.
Subjects:
Adult swine, both genders.
Interventions:
Cryogenic brain injury with intravenous fluid infusion of either lactated Ringer's solution or 6% dextran-70 in normal saline. The effect of this intervention was monitored for 24 hrs.
Measurements:
Mean arterial pressure, central venous pressure, intracranial pressure, hemoglobin concentration, plasma oncotic pressure, serum osmolality, cerebral blood flow, and specific gravity of cortical biopsies.
Results:
Cryogenic injury significantly increased the cortical water content and the intracranial pressure and significantly decreased the cerebral blood flow and oxygen delivery (p < .05). Dextran infusion significantly increased the colloid oncotic pressure. There were no differences between the lactated Ringer's solution and dextran groups in intracranial pressure, cerebral oxygen delivery, or cortical water content after 24 hrs.
Conclusions:
Colloid infusion after a focal cryogenic injury does not increase cerebral oxygen delivery or reduce either cerebral edema formation or intracranial pressure when compared with lactated Ringer's solution. Colloid is not superior to isotonic crystalloid in the management of isolated brain injury.