Delayed Fluid Resuscitation of Head Injury and Uncontrolled Hemorrhagic Shock

Abstract

Objective: To evaluate the effects of delayed vs early fluid resuscitation on cerebral hemodynamics after severe head injury and uncontrolled hemorrhagic shock.

Early treatment with lyophilized plasma protects the brain in a large animal model of combined traumatic brain injury and hemorrhagic shock

“…Slices were incubated in 2% 2,3,5-triphenyltetrazolium chloride (TTC) (SigmaChemical Co., St. Louis, MO) to detect nonviable tissue. 20 Lesion size was measured with computer-assisted image analysis software ImageJ (National Institutes of Health, Bethesda, MD). Brain swelling was calculated by comparing the injured hemisphere with the uninjured hemisphere [(ipsilateral hemisphere's volume / contralateral hemisphere's volume) j 1] Â 100.…”

Improving on Laboratory Traumatic Brain Injury Models to Achieve Better Results

“…Models that have tried to explain the effects of posttraumatic hypotension have done so more commonly in larger animals such as pigs and cats relatively to rodents. It is worth nothing that many and several studies have been conducted on the effects of fluid resuscitation strategies after traumatic brain injury44-50 while posttraumatic hypotensive effects have been poorly dealt with in the laboratory environment. Majority of these animal models of TBI have been able to include parameters such as intracranial pressure monitoring, cerebral blood flow, oxygen delivery and so on but very few have been able to be compared with secondary insults, hence it is easy to speculate that these models have been limited in their capacity to specifically explain the mechanisms of neuronal damage intensified by secondary insults leading to some of the failures pertaining to translating laboratory results to the bedside.…”

Role of colloids in traumatic brain injury: Use or not to be used?

“…In comparison to colloids, crystalloids were shown to produce more cerebral edema in TBI patients. [1819] It is likely that in severe head injury patients (with disrupted BBB), edema formation would be even worse with the further use of crystalloids. The high oncotic pressure of colloids decreases the cerebral edema formation and is also associated with improvement in the mean arterial blood pressure (MABP), having low infused volume, and decreased neuronal death.…”