Seriously ill patients with traumatic brain injury are often given too much fluid in the ICU. These positive fluid balances are associated with poorer outcomes. This is evident from a large multicenter study in The Lancet Neurology of Erasmus MC researchers Hester Lingsma, Eveline Wiegers and Mathieu van der Jagt, among others.
In the CENTER TBI Study the treatment outcomes of 63 centers in eighteen countries were compared. According to the last author and neuro-intensivist Mathieu van der Jagt, there were major differences between centers. Using statistical techniques, they weighed and filtered out patient differences.
Fluid is given to optimize blood flow in the brain. Van der Jagt: ‘Too little is always wrong, but the adage is that too much probably does less harm. In fact, with a subarachnoid hemorrhage we gave a lot of fluid as a treatment. We’re coming back from that now.’ In many centers the danger of too much moisture is not seen as such, says Van der Jagt. ‘Not only do patients sometimes receive “half a liter extra” of fluid, but many medicines are also dissolved in fluid, such as paracetamol or antibiotics that can also be administered via the stomach as a pill’.
Many doctors and nurses do not realize that sometimes a patient receives as much as four or five liters of fluid a day. Patients with low blood pressure often receive extra fluids. ‘But then they usually don’t have a lack of fluids, but a lack of the stress hormone noradrenaline. In fact, in many cases you have to increase that and not give moisture. The conclusion is that too little and too much IV fluids can be harmful. We had lost sight of the latter in these patients’, says Van der Jagt.
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