Traumatic brain injury – A review of intravenous fluid therapy.

• Up to 34% of dogs & cats with blunt trauma will have head & neck injury.
• Head trauma is significantly associated with mortality at 24-35%

Reviews anatomy & physiology of normal BBB, pathophysiology at membrane level associated with disruption of BBB & effect of disruption on cerebral blood flow.

Brain Trauma Foundation does not recommend any specific fluid type.

Lund Concept discusses use of albumin & vasodilators but lacks strong evidence.

No clinical trials evaluating any fluid type in veterinary patients with hemorrhagic shock & TBI.

Discusses isotonic crystalloids, synthetic colloids, natural colloids, hyperosmolar therapy & treatments on horizon.

Isotonic crystalloids: laboratory studies showed worse brain pathology when resuscitated with isotonic crystalloids compared with any plasma product.

Synthetic colloids: faster resuscitation compared with isotonic crystalloids, less cerebral edema, both groups hypercoagulable, not as effective as plasma; no valid conclusion in 1 clinical trial.

Natural colloids: resuscitation with 4% albumin uncertain maybe because of hyperosmolality, fresh frozen plasma may help heal BBB, plasma outperforms isotonic crystalloids and synthetic colloids but depends on type of injury.

Hyperosmolar fluids (mannitol, hypertonic saline [HTS]): improvement in brain pathology when used for resuscitation, improvement in intracranial pressure (ICP) in short term but no improvement in survival or long term neurologic outcome; optimal doses unknown.

Treatments on horizon: adenosine/lidocaine/magnesium, hemoglobin-based oxygen carriers, perfluorocarbon.

Maximize cerebral perfusion pressure by correcting systemic hypotension. 

Lactated Ringer’s solution may be less desirable than other isotonic crystalloids.

Plasma products may lead to improved outcome.