Trauma Resuscitation and Fluid Considerations in the Polytrauma Patient with CNS Injury

Polytrauma that includes the central nervous system presents a challenge to both surgical and neurocritical care teams as optimal fluid administration during resuscitation must facilitate hemostasis and restore intravascular volume, without worsening the secondary brain injury. Care must be taken to avoid edema systemically, as well as to the injured brain and its already compromised microvasculature and blood brain barrier. Fluid balance is an important consideration as well as the type of fluid administered. In addition to hyperosmolar agents, other fluids and adjunctive therapies such as platelets and fresh frozen plasma have emerged as options with both systemic and neuroprotective benefits. Evaluating resuscitation in traumatic brain injury is complex, and intracranial pressure along with cerebral perfusion pressure management alone may not be adequate to significantly impact clinical outcomes. Robust clinical trials must be designed so that the promising therapies that have emerged from preclinical studies can be adequately translated and evaluated with clinically relevant and measurable outcomes.