Question:
I'm prepraring a case study on Traumatic Brain Injury, specifically unconsious with hypotension, and am just inquiring as to the fluid used to resusitate these people in your district.

We currently infuse N.Saline to maintain a (approx) normal BP, but I'm thinking of looking at Hypertonic Saline in my case study. Does anyone out there use this (with or without addatives), and with what protocol? What about other hyperosmolar/hyperoncotic fluids? Any evidence to back up your districts choice of fluid?

Answer: Much of the more current thinking suggests that it's better to be a little hypotensive, than normotensive. Increasing BP through fluid resuscitation also increases hemorrhage.

The caveat is that you don't want to be too hypotensive as brain perfusion will suffer. We tend to not strive for anything above 90 mm/Hg, but we're in an urban system with relatively short transport to a Level I trauma center.

I don't know if there are more recent studies, but when I looked at Hypertonic Saline 2-3 years ago, patient outcome didn't improve with it's use.