Effect of limited fluid resuscitation for craniocerebral injury combined with multiple trauma

Abstract

Objective To investigate the fluid resuscitation strategies to craniocerebral injury patients combined with multiple trauma. Methods This retrospective review was made on 124 patients with combined craniocerebal injury (GCS 3-12 points) plus multiple trauma. Based on the fluid resuscitation strategies, 63 patients were treated with aggressive fluid resuscitation (AFR), and 61 with limited fluid resuscitation (LFR). A restrictive rehydration principle was performed with intensive hemodynamic monitoring: mean arterial pressure was kept between 70-80 mmHg for 48 hours and central venous pressure between 6-8 cmH2O for 48 hours in LFR group; mean arterial pressure was kept in basic level and central venous pressure between 8-12 cmH2O in AFR group. No significant differences were shown in the rest of treatments. Parameters were compared between groups such as blood pressure, shock index, coagulation function, imaging data, GCS, and GOS at 6 months postinjury. Results Between-group differences were insignificant with regard to mean arterial pressure (MAP), shock indices, ISS, trauma severity indices (TSI), and GCS (P>0.05). Blood pressure fluctuation in LFR group was (18.5±9.9)mmHg vs (29.4 ±11.1)mmHg in AFR group (P<0.01). Eight patients developed intracranial hemorrhage progression in LFR group, with 3 being treated with craniotomy. In comparison, 19 patients developed intracranial hemmorrhage progression in AFR group, with 10 being treated with craniotomy(P<0.01). Improvement in coagulation disorders was better in LFR group than in AFR group. On days 7 after admission, GCS in LFR groups was (9.1±3.6) points vs (7.2±2.3)points in AFR group (P<0.05). At 6-month follow-up, results were 34 good and 27 poor in LFR group, better than 23 good and 40 poor in AFR group. Conclusion For moderate to severe craniocerebral injury combined with multiple trauma, LFR is effective to treat coagulation disorders and hemorrhagic shock, reduce the probability of delayed intracranial hemorrhage, and further improve the outcome. Key words: Craniocerebral trauma; Multiple trauma; Limited fluid resuscitation