Balanced Fluid Versus Saline-Based Fluid in Post-operative Severe Traumatic Brain Injury Patients: Acid-Base and Electrolytes Assessment|
Hassan, Mohamad Hasyizan; Wan Hassan, Wan Mohd Nazaruddin; Zaini, Rhendra Hardy Mohd; Shukeri, Wan Fadzlina Wan Muhd; Zainal Abidin, Huda & Chong, Soon Eu
Background: Normal saline (NS) is a common fluid of choice in neurosurgery and neurointensive
care unit (ICU), but it does not contain other electrolytes and has the potential to cause
hyperchloremic metabolic acidosis with prolonged infusion. These problems may be reduced
with the availability of balanced fluid (BF), which becomes a more physiological isotonic solution
with the presence of complete electrolyte content. This study aimed to compare the changes in
electrolytes and acid–base between NS and BF (Sterofundin® ISO) therapy for post-operative
severe traumatic brain injury (TBI) patients in neuro-ICU.
Methods: Sixty-six severe TBI patients who required emergency craniotomy or
craniectomy and were planned for post-operative ventilation were randomised into NS (n = 33)
and BF therapy groups (n = 33). The calculation of maintenance fluid given was based on the
Holliday-Segar method. The electrolytes and acid–base parameters were assessed at an 8 h
interval for 24 h. The data were analysed using repeated measures ANOVA.
Results: The NS group showed a significant lower base excess (-3.20 versus -1.35,
P = 0.049), lower bicarbonate level (22.03 versus 23.48 mmol/L, P = 0.031), and more
hyperchloremia (115.12 versus 111.74 mmol/L, P < 0.001) and hypokalemia (3.36 versus 3.70
mmol/L, P < 0.001) than the BF group at 24 h of therapy. The BF group showed a significantly
higher level of calcium (1.97 versus 1.79 mmol/L, P = 0.003) and magnesium (0.94 versus 0.80
mmol/L, P < 0.001) than the NS group at 24 h of fluid therapy. No significant differences were
found in pH, pCO2, lactate, and sodium level.
Conclusion: BF therapy showed better effects in maintaining higher electrolyte
parameters and reducing the trend toward hyperchloremic metabolic acidosis than the NS
therapy during prolonged fluid therapy for postoperative TBI patients.
balanced solution; sodium chloride; severe traumatic brain injury; critical care; electrolytes, acid–base balance