Monitoring Of Fluid Balance Research Articles

The path to individualization of infusion therapy for emergency conditions according to the ROSE concept

The article is devoted to the role of intravenous fluid therapy in conditions of impaired fluid homeostasis, which often occur during major surgical interventions and critical conditions, such as sepsis and trauma. The importance of adequate fluid administration to maintain cellular homeostasis, as well as the management of conditions associated with hypovolemia and hemodynamic disturbances, is described. It is noted that, despite numerous studies, the topic of optimal fluid management strategies remains controversial, with potential risks of adverse effects of excessive fluid administration on clinical outcomes. The concept of liquid resuscitation ROSE is presented, which includes four stages: resuscitation, optimization, stabilization and evacuation. This concept will assist physicians in making decisions about fluid therapy management. Different types of fluids are reviewed, including balanced solutions and the multifunctional hyperosmolar solution Reosorbilact, and the importance of individualizing therapy based on the needs of each patient is emphasized. The importance of the need for careful monitoring and control of fluid balance is emphasized to avoid complications and ensure improved clinical outcomes

Critical Importance of Close Monitoring of Sodium and Fluid Balance in Labor and Delivery

Critical Importance of Close Monitoring of Sodium and Fluid Balance in Labor and Delivery

Anesthesia Management in Antenatal Care for Women With Chronic Kidney Disease: A Comprehensive Review.

Chronic kidney disease (CKD) presents significant challenges in the management of pregnant women due to its impact on renal function and cardiovascular stability. This review examines the crucial role of anesthesia management in antenatal care for women with CKD, focusing on the complexities introduced by renal dysfunction and the implications for maternal and fetal health outcomes. The review discusses the physiological changes in CKD during pregnancy, highlighting the increased risks of hypertension, proteinuria, and adverse fetal outcomes. Anesthesia considerations, including the choice of anesthesia techniques (general anesthesia, regional anesthesia), perioperative monitoring, and management of fluid and electrolyte balance, are analyzed in the context of CKD-specific challenges. Clinical outcomes and current evidence regarding anesthesia efficacy and safety in CKD patients are reviewed, emphasizing the need for tailored anesthesia protocols to ensure optimal maternal comfort and fetal safety. The review concludes by identifying research gaps and proposing future directions to enhance anesthesia practices and improve outcomes for pregnant women with CKD undergoing surgical interventions or labor management.

Evaluation of a real-life experience with a digital fluid balance monitoring technology.

Innovations in healthcare technologies have the potential to address challenges, including the monitoring of fluid balance. This study aims to evaluate the functionality and accuracy of a digital technology compared to standard manual documentation in a real-life setting. The digital technology, LICENSE, was designed to calculate fluid balance using data collected from devices measuring urine, oral and intravenous fluids. Participating patients were connected to the LICENSE system, which transmitted data wirelessly to a database. These data were compared to the nursing staff's manual measurements documented in the electronic patient record according to their usual practice. We included 55 patients in the Urology Department needing fluid balance charting and observed them for an average of 22.9 hours. We found a mean difference of -44.2 ml in total fluid balance between the two methods. Differences ranged from -2230 ml to 2695 ml, with a divergence exceeding 500 ml in 57.4% of cases. The primary source of error was inaccurate or omitted manual documentation. However, errors were also identified in the oral LICENSE device. When used correctly, the LICENSE system performs satisfactorily in measuring urine and intravenous fluids, although the oral device requires revision due to identified errors.

Fluid accumulation in critically ill children: a systematic review and meta-analysis

Fluids are often administered for various purposes, such as resuscitation, replacement, maintenance, nutrition, or drug infusion. However, its use is not without risks. Critically ill patients are highly susceptible to fluid accumulation (FA), which is associated with poor outcomes, including organ dysfunction, prolonged mechanical ventilation, extended hospital stays, and increased mortality. This study aimed to assess the association between FA and poor outcomes in critically ill children. In this systematic review and meta-analysis, we searched PubMed, Embase, ClinicalTrials.gov, and Cochrane Library databases from inception to May 2024. Relevant publications were searched using the following terms: child, children, infant, infants, pediatric, pediatrics, critically ill children, critical illness, critical care, intensive care, pediatric intensive care, pediatric intensive care unit, fluid balance, fluid overload, fluid accumulation, fluid therapy, edema, respiratory failure, respiratory insufficiency, pulmonary edema, mechanical ventilation, hemodynamic instability, shock, sepsis, acute renal failure, acute kidney failure, acute kidney injury, renal replacement therapy, dialysis, mortality. Paediatric studies were considered eligible if they assessed the effect of FA on the outcomes of interest. The main outcome was all-cause mortality. Pooled analyses were performed by using random-effects models. This review was registered on PROSPERO (CRD42023432879). A total of 120 studies (44,682 children) were included. Thirty-five FA definitions were identified. In general, FA was significantly associated with increased mortality (odds ratio [OR] 4.36; 95% confidence interval [CI] 3.53-5.38), acute kidney injury (OR 1.98; 95% CI 1.60-2.44), prolonged mechanical ventilation (weighted mean difference [WMD] 38.1h, 95% CI 19.35-56.84), and longer stay in the intensive care unit (WMD 2.29 days; 95% CI 1.19-3.38). The percentage of FA was lower in survivors when compared to non-survivors (WMD-4.95 [95% CI,-6.03 to-3.87]). When considering only studies that controlled for potential confounding variables, the pooled analysis revealed 6% increased odds of mortality associated with each 1% increase in the percentage of FA (adjusted OR=1.06 [95% CI, 1.04-1.09). FA is significantly associated with poorer outcomes in critically ill children. Thus, clinicians should closely monitor fluid balance, especially when new-onset or worsening organ dysfunction occurs in oedematous patients, indicating potential FA syndrome. Future research should explore interventions like restrictive fluid therapy or de-resuscitation methods. Meanwhile, preventive measures should be prioritized to mitigate FA until further evidence is available. None.

The Influence of Preoperative Anticoagulant and Antiplatelet Therapy on Rebleeding Rates in Patients Suffering from Spinal Metastatic Cancer: A Retrospective Cohort Study.

The age of patients requiring surgery for spinal metastasis, primarily those over 65, has risen due to improved cancer treatments. Surgical intervention targets acute neurological deficits and instability. Anticoagulants are increasingly used, especially in the elderly, but pose challenges in managing bleeding complications. The study examines the correlation between preoperative anticoagulant/antiplatelet use and bleeding risks in spinal metastasis surgery, which is crucial for optimizing patient outcomes. In a retrospective study at our department from 2010 to 2023, spinal tumor surgery patients were analyzed. Data included demographics, neurological status, surgical procedure, preoperative anticoagulant/antiplatelet use, intra-/postoperative coagulation management, and the incidence of rebleeding. Coagulation management involved blood loss assessment, coagulation factor administration, and fluid balance monitoring post-surgery. Lab parameters were documented at admission, preop, postop, and discharge. A cohort of 290 patients underwent surgical treatment for spinal metastases, predominantly males (63.8%, n = 185) with a median age of 65 years. Preoperatively, 24.1% (n = 70) were on oral anticoagulants or antiplatelet therapy. Within 30 days, a rebleeding rate of 4.5% (n = 9) occurred, unrelated to preoperative anticoagulation status (p > 0.05). A correlation was found between preoperative neurologic deficits (p = 0.004) and rebleeding risk and the number of levels treated surgically, with fewer levels associated with a higher incidence of postoperative bleeding (p < 0.01). Surgical intervention for spinal metastatic cancer appears to be safe regardless of the patient's preoperative anticoagulation status. However, it remains imperative to customize preoperative planning and preparation for each patient, emphasizing meticulous risk-benefit analysis and optimizing perioperative care.

A rare diagnosis of Langerhans cell histiocytosis made on thyroid histology with coexisting papillary thyroid cancer and AVP deficiency.

A 48-year-old Asian male, presented to the hospital for an elective total thyroidectomy in the context of 6.3 cm thyroid nodule. The fine needle aspiration cytology of the nodule confirmed papillary thyroid cancer (PTC) with some atypical histiocytes. He has a history of idiopathic arginine vasopressin deficiency (AVP-D) and has been taking oral DDAVP 100 µg daily, self-adjusting the dose based on thirst and polyuria. Additionally, he also has a history of recurrent spontaneous pneumothorax. His total thyroidectomy was aborted due to significant intraoperative bleeding, and his admission was further complicated by post-operative hyponatraemic seizure. Thyroid histology revealed the diagnosis of Langerhans cell histiocytosis (LCH), and further investigation with contrast CT demonstrated multi-organ involvement of the thyroid, lungs, and bones. Langerhans cell histiocytosis (LCH) is a condition that can affect one or more organ systems, including the pituitary, where it can present as AVP deficiency. Strict monitoring of fluid balance, as well as serial monitoring of serum sodium, is essential in all patients with AVP-D in the perioperative setting. Iatrogenic hyponatraemic seizure is an uncommon but serious complication of DDAVP treatment in hospitalised patients with AVP-D. DDAVP dosing must be carefully monitored. LCH with multisystem involvement is an important mimic for metastatic conditions, and histological diagnosis is essential to guide treatment and prognosis. Although LCH without bone marrow involvement is unlikely to increase the risk of bleeding, its effect on tissue integrity may make surgery more challenging. BRAF-V600E mutation is an important driver mutation and a potential therapeutic target in the treatment of LCH.

Digitizing fluid balance monitoring may offer a solution for optimizing patient care.

Precise fluid balance monitoring is essential for patient treatment, as incorrect fluid balance can lead to disorders. This study aimed to assess the accuracy of the digital technology LICENSE (LIquid balanCE moNitoring SystEm) for fluid balance charting and compare it to the standard method (SM) to determine its usability in clinical practice. This prospective study included 20 patients. The results from LICENSE were compared to those from SM and a reference measurement (manual weight of fluids, RM). Three LICENSE devices were used for urine output, intravenous fluids, and oral fluid intake. The accuracy of methods was evaluated using Bland Altman plots. The mean difference between LICENSE and RM was less than 2 millilitres (p= 0.031 and p= 0.047), whereas the mean difference between SM and RM was 6.6 ml and 10.8 ml (p< 0.0001). The range between the upper and lower limits of agreement was between 16.4 and 27.8 ml for LICENSE measurements and 25.2 and 52 ml for SM. LICENSE is comparable to or more accurate than the standard method for fluid balance monitoring. The use of LICENSE may improve the accuracy of fluid balance measurements. Further research is needed to evaluate its feasibility in daily clinical practice.

Nutritional physiology and body composition changes during a rapid ascent to high altitude.

Exposure to high altitude might cause the body to adapt with negative energy and fluid balance that compromise body composition and physical performance. In this field study involving 12 healthy adults, sex-balanced, and aged 29±4 years with a body mass index of 21.6±1.8kg/m2, we investigated the effects of a 4-day trekking up to 4556m a.s.l. on Monte Rosa (Alps, Italy). The food intake was recorded using food diaries and nutrient averages were calculated. The bio-impedance analysis was performed at low and high altitudes, and a wearable biosensor (Swemax) was used to track hydro-saline losses in two participants. Daily total energy intake was 3348 ± 386kcal for males and 2804 ± 415kcal for females (13%-14% protein, 35% fat, 44%-46% carbohydrates). Although there was a significant body weight loss (65.0±9.3vs. 64.2±9.10kg, p<0.001, d=1.398), no significant changes in body composition parameter were found but a trend in the increase of the bioelectrical phase angle in males (p=0.059, d = -0.991). Body water percentage significantly changed (p=0.026, η2 p=0.440), but the absolute water did not, suggesting that the weight loss was not due to water loss. Salivary and urinary osmolality did not change. A reduction in sweat rate at higher altitudes was observed in both participants. Interestingly, salivary leptin increased (p=0.014, η2 p=0.510), and salivary ghrelin decreased (p=0.036, η2 p =0.403). Therefore, the 4-day trekking at altitude of hypoxia exposure induced changes in satiety and appetite hormones. High altitude expeditions require more specific nutritional guidance, and using multiplex analysis could help in monitoring fluid balance and body composition.

Copper nanoparticles and silver nanoparticles impair lymphangiogenesis in zebrafish

Lymphatic system distributes in almost all vertebrate tissues and organs, and plays important roles in the regulation of body fluid balance, lipid absorption and immune monitoring. Although CuNPs or AgNPs accumulation has been reported to be closely associated with delayed hatching and motor dysfunction in zebrafish embryos, their biological effects on lymphangiogenesis remain unknown. In this study, thoracic duct was observed to be partially absent in both CuNPs and AgNPs stressed zebrafish larvae. Specifically, CuNPs stress induced hypermethylation of E2F7/8 binding sites on CCBE1 promoters via their producing ROS, thereby leading to the reduction of binding enrichment of E2F7/8 on CCBE1 promoter and its subsequently reduced expression, then resulting in defective lymphatic vessel formation. Differently, AgNPs stress induced down-regulated CCBE1 expression via down-regulating mRNA and protein levels of E2F7/8 transcription factors, thereby resulting in defective lymphatic vessel formation. This study may be the first to demonstrate that CuNPs and AgNPs damaged lymphangiogenesis during zebrafish embryogenesis, mechanistically, CuNPs epigenetically regulated the expression of lymphangiogenesis regulator CCBE1 via hypermethylating its promoter binding sites of E2F7/8, while AgNPs via regulating E2F7/8 expression. Meanwhile, overexpression of ccbe1 mRNA effectively rescued the lymphangiogenesis defects in both AgNPs and CuNPs stressed larvae, while overexpression of e2f7/8 mRNA effectively rescued the lymphangiogenesis defects in AgNPs rather than CuNPs stressed larvae. The results in this study will shed some light on the safety assessment of nanomaterials applied in medicine and on the ecological security assessments of nanomaterials.-5JubNCLudCTXxnkfqD8auVideo

Management of Low Sodium in AMU

Hyponatremia is a common finding in acutely ill patients and is defined as serum sodium (Na) level less than 135 mEq/L which is due to a relative excess of water in relation to serum sodium. Reasons for hyponatremia are increase in water intake (hypotonic intravenous fluid therapy or primary polydipsia) or impaired water excretion due to renal failure or increase release of antidiuretic hormone. Optimum management depends on the duration and severity of hyponatremia and involves close monitoring and accurate fluid balance assessment. We will discuss in this article the basics of management, pitfalls to avoid in Hyponatremia and recommended approach based on literature review when reviewing a patient with Hyponatremia, firstly to enquire about the duration of Hyponatremia to differentiate acute from chronic as the threshold for treatment is different, following duration is assessment of severity (clinically by symptoms and signs as well as biochemistry) as severity will affect the management. Following duration and severity the acute physician should assess the volume status of the patient to hypovolemic, euvolemic or hypervolemic Hyponatremia which aids in reaching the possible cause of Hyponatremia and the right treatment.

Quality of fluid balance charting and interventions to improve it: a systematic review

IntroductionFluid balance monitoring is pivotal to patients’ health. Thus, fluid balance charting is an essential part of clinical nursing documentation. This systematic review aimed to investigate and describe the quality...

Induced seismicity traffic light protocol at the Alberta No. 1 geothermal project site

The Alberta No. 1 Geothermal Project (ABNo1) is a renewable energy project in Canada; it will use deep geothermal energy for electrical power generation and direct-use thermal power. However, concerns regarding induced seismicity must be addressed. This study proposes implementing the Traffic Light Protocol (TLP) as a risk management tool for conventional geothermal projects in Alberta. We focus on determining an appropriate TLP red-light threshold, employing a risk-informed approach for the Leduc Formation - one of the geothermal reservoirs proposed for development by ABNo.1. The recommended red-light threshold of ML 3.5 signifies the level at which operations must be halted (i.e., the red light) to mitigate nuisance impact, damage, and personal risk. The recommended yellow light threshold of ML 1.5 signifies the level at which assessment of injection operations must be re-assessed, the regulator must be informed, and a risk mitigation analysis must be undertaken to re-evaluate operations to keep induced seismicity at a low magnitude. Comparison to induced seismicity near the project site highlights key factors requiring consideration during the project's design phase: injection volume, chances of basement fault reactivation, and delayed seismic activity onset. Effective mitigation entails controlling injection rate, continuous fluid balance monitoring, allowing gradual and appropriate pressure dissipation rates, and potentially the use of tracer tests to deconvolve pathways. This study provides insights for stakeholders involved in injection projects, aiding risk mitigation and ensuring safe, sustainable energy extraction while also prioritizing the local community's well-being.

Operative Hysteroscopy Intravascular Absorption Syndrome - A Life-Threatening Complication.

OHIA syndrome occurs due to the systemic absorption of the irrigation fluid used during hysteroscopic procedures.The presentation is diverse with encephalopathy, pulmonary oedema, dysrhythmias, electrolyte disturbances and coagulopathy.Fluid balance and irrigation fluid pressures should be monitored during hysteroscopic procedures to mitigate OHIA development.

1246 High Output Stoma Management Audit

Abstract Aim High output stomas lead to a myriad of complications for patients including dehydration, electrolyte imbalances, poor skin integrity &amp; altered bowel function. However, this issue is not well recognised amongst junior doctors. This audit’s aim was to improve awareness of high output stomas including their implications and management according to the Association of Stoma Care Nurses’ (ASCN) national guidelines amongst junior doctors. Method An electronic survey was distributed to 20 junior doctors working in General Surgery at Southend University Hospital, assessing their knowledge on recognition and management of high output stomas. A checklist summarising the ASCN guidelines was then created. A post-intervention survey was then distributed to assess for improvement in knowledge and application of ASCN guidelines as well as use of the checklist. Results Overall, 51% answers were correct in the first survey compared to 72% answers correct in the post-intervention survey, and 83% of participants used the checklist. There was improvement in use of IV fluids (50% to 100%), monitoring fluid balance (80% to 91%), fibre restriction (37% to 70%), fluid restriction (50% to 70%), checking &amp; replacing Mg (65% to 87%) &amp; use of regular codeine (70% to 77%), as well as moderate improvement in appropriate doses of loperamide being given (5% to 30%). Conclusions The above audit resulted in an improvement of knowledge and application of evidence-based guidance provided by ASCN, with ultimate intent to improve patient outcomes. Further work includes distribution of the checklists throughout the hospital and to other hospitals.

SP9.17 Adherence to fluid guidelines in surgical patients and impact on complication rate

Abstract Aims Up to 95% of intravenous fluid prescription requests for surgical patients are executed by Foundation Year-1(FY1) doctors. This, notwithstanding the plethora of studies suggesting FY1 doctors are inadequately equipped to be prescribing fluids unsupervised. Poor intravenous fluid therapy is associated with an approximate 20% complication rate, including electrolyte abnormalities, dysrhythmia and fluid overload. Methods A closed-loop audit was performed at a large teaching hospital to examine compliance with fluid prescribing guidelines and associated complications. This involved a 4-week retrospective review of drug prescription charts against NICE guidelines followed by a targeted intervention that involved a dedicated teaching session on fluid management in the surgical patient, alongside posters and crib sheets of fluid management on surgical wards. The re-audit using the same criteria compared proportion of prescription errors, over- or under-hydration, and total complications before and after intervention. Results 308 patient records were reviewed (pre-intervention n=185; post-intervention n=123). Documentation of fluids indication (31% vs 46%(p&amp;lt;0.0414)), contingency plans (3% vs 38%(p&amp;lt;0.0001)) and glucose prescription for nil per os patients on maintenance fluids (10% vs 25% (p=0.0029)) improved post-intervention. Fluid balance monitoring (29% vs 9%(p=0.0001)) worsened. The proportion of patients receiving insufficient potassium (91% both rounds), excess sodium (90% vs 92% (p=0.6212)), and the average rate of complications (1 in 1.67 vs 1 in 1.54, p=0.4652) remained unchanged. Conclusion Didactic educational intervention for FY1 doctors on fluid therapy improved documentation on fluids indication, but failed to resolve significant prescription failures and resulted in similar complication rates pre-and post-intervention.

Monitoring Book Mempengaruhi Balance Cairan pada Pasien DBD Anak

Introduction: Regions in West Java have the highest DHF case fatality records, one of which is Bogor Regency. Bina Husada Hospital is one of the hospitals that treats many pediatric DHF patients. Lack of fluids is the most common cause for pediatric DHF patients at Bina Husada Hospital. Objectives: To determine the effect of the Monitoring Book on Fluid Balance in DHF Children Method: Quantitative research with experimental research methods. The research design used was pre-experimental in the form of a one-shot case study. One-shot case study. The population in this study were patients with inclusion criteria: pediatric DHF patients who had been treated with fever for 4-6 days at Bina Husada Hospital, pediatric DHF patients who were willing to become respondents, and families of child DHF patients. The sample of this study was 20 respondents of DHF children. Collecting data in this study by providing observation sheets for monitoring book services, while the analysis used the paired t-test method. Result: The results of the study showed that the fluid balance of pediatric DHF patients before and after carrying out monitoring of fluid balance in pediatric DHF patients with the resulting p-value was 0.002 Conclusion: There is an effect of applying the monitoring book on the fluid balance of pediatric DHF patients.

Fluid Balance and Hemodynamic Monitoring of Traumatic Brain Injured Patients: An International Survey.

Robba, Chiara MD, PhD*,†; van der Jagt, Mathieu PhD‡; Taccone, Fabio PhD§; Citerio, Giuseppe MD∥; Messina, Antonio PhD¶,# Author Information

#6838 SAFETY OF RAMADAN FASTING IN DIALYSIS PATIENTS: A TUNISIAN PROSPECTIVE MULTICENTER STUDY

Abstract Background and Aims Hemodialysis patients are generally exempt from Ramadan Fasting (RF) because they are more vulnerable to the risk of malnutrition as well as fluid and electrolyte imbalance. In addition, many muslim hemodialysis patients feel the spirituel need to fast during Ramadan, even when they are not compelled to do so. Moreover, there are no medical recommendations that specify who should and should not fast. The aim of our study is to explore the experiences of Muslim Hemodialysis patients fasting Ramadan in Hemodialysis centers. Method This prospective multicenter study involved patients from eight different hemodialysis centers in Monastir and Mahdia cities. Biochemical, clinical parameters and bioimpedance monitoring were performed before, during and after Ramadan with a group of Fasting Ramadan patients (RFG) and a group of Ramadan non-fasting hemodialysis patients (RNFG). Patients in RFG did so as a personal choice and they wouldn't skip fasting on dialysis days due to fear of the side effects of fasting. Oral consent was taken from all the patients included in the study. Results One hundred and four (104) patients were enrolled in this study. Among them, 44 were in the RFG, and the remaining sixty (60) patients were in the RNFG. The mean age of RFG and RNFG was 47, 13 +/- 12 years and 54, 7 +/- 15 years, respectively. 32 patients (52, 3 %) were males in RFG and 38 were males (63, 3%) in RNFG. In RFG, about 6, 8% (n = 3) and 43, 2% (n =19) had diabetes and hypertension, respectively. The mean duration on hemodialysis was 7 +/- 6, 27 years. There were no significant differences between RFG and RNFG except in diabetic and hypertension status. Comparing biological findings pre,during and post-fasting,in RFG, no significant differences were noted in serum sodium (135,9 +/- 4 ; 135,8 +/- 2,5 and 136,3 +/- 2,4 mmol/l respectively) ; and there were no drop in serum albumin during fasting (40,4 +/- 3,4 ; 40,8 +/- 3,7 and 40,6 +/- 4,34 g/l respectively). However, mean serum potassium was higher during RF (5,59 +/- 0,8 ; 5,6 +/- 1 and 5,2 +/- 0,88 mmol/l respectively) and, mean serum Phosphorus was also higher during RF (1,54 +/- 0,57; 1,73 +/- 0,52 and 1,69 +/- 0,7 mmol/l respectively). Furthermore, with bioimpedance monitoring, comparing pre, during and post Fasting, more fluid retention in patients was observed during fasting (51, 67 +/- 7; 54, 3 +/- 7, 4 and 53, 2 +/- 6 % respectively). But the mean of the inter dialytic weight gain (IDWG) remained the same (2,57 +/- 0,8 ; 2,53 +/- 0,82 and 2,61 +/- 0,7 Kg respectively), and none presented with pulmonary oedema or other emergency that might need hospitalization. However, there was positive change to body composition between pre and during fasting, shown as lower body fat mass (FM) percentage during fasting (29,4 and 28,2% respectively) and also, lower body mass index (BMI) (26,5 and 25,9 respectively). Nevertheless, when comparing findings between RFG and RNFG, there was no significant difference in any parameters. Conclusion The overall conclusions suggest that fasting is relatively well tolerated by hemodialysis patients and does not affect the morbidity and mortality rates. However, careful monitoring of fluid balance, serum electrolytes, and albumin is advisable.

Insights into Hemodynamic Features of Survivors and the Deceased with Acute Brain Injury: A Step Forward Tailored Treatment.

Pulmonary artery catheters are widely used for hemodynamical monitoring in critically ill patients. Acute brain injury is among the severe conditions treated in an intensive care unit. The advanced monitoring of hemodynamical parameters, fluid balance and adequate administered treatment based on those values are components of goal-directed therapy. A prospective observational study included adult patients who were hospitalized in the ICU due to acute bran injury, excluding brain oedema after cardiac arrest. Each patient had PAC inserted and hemodynamic data were collected during the first 3 days of the ICU stay every 6 h. Patients were divided into two groups based on the endpoint: the survivors and the deceased. Length of stay in hospital differed between patiens. All patients, regardless of their outcome, had noradrenaline administered. The initial values of PAP differed between the groups (p = 0.05). There were positive correlations noticed between noradrenaline dose, CVP and fluid balance when compared to PCWP in a group of survivors and a positive correlation in the fluid balance when compared to PAP and PVRI. Lactate serum concentrations presented a correlation with the dose of noradrenaline in both groups. Upon acute brain injury, values of PVRI and PAP increase. This is corelated with fluid load and worsened by an excessive fluid treatment in the case of an inconsiderate approach for stabilizing the patient hemodynamically. PAC may present limited advantages in terms of PAP and PVRI control during the treatment.