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Review

A Comprehensive Review of Fluid Resuscitation Strategies in Traumatic Brain Injury

1
Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, 3012 Bern, Switzerland
2
Academic Department of Emergency Medicine, School of Medicine, University of Cyprus, 1678 Nicosia, Cyprus
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2025, 14(17), 6289; https://doi.org/10.3390/jcm14176289
Submission received: 15 July 2025 / Revised: 31 August 2025 / Accepted: 3 September 2025 / Published: 5 September 2025

Abstract

The current management of severe traumatic brain injury (TBI) focuses on maintaining cerebral perfusion pressure (CPP) to prevent or minimize secondary brain injury, limit cerebral edema, optimize oxygen delivery to the brain, and reduce primary neuronal damage by addressing contributing risk factors such as hypotension and hypoxia. Hypotension and cardiac dysfunction are common in patients with severe TBI, often requiring treatment with intravenous fluids and vasopressors. The primary categories of resuscitation fluids include crystalloids, colloids (such as albumin), and blood products. Fluid osmolarity is a critical consideration in TBI patients, as hypotonic fluids, such as balanced crystalloids, may increase the risk of cerebral edema development and worsening. Hyperosmolar therapy is a common therapeutic approach in patients with intracranial hypertension; however, its use as a resuscitation fluid is not associated with benefits in patients with TBI and is not recommended. Given the contradictory results of trials on blood transfusion strategies in patients with TBI, the transfusion approach should be tailored to individual systemic and cerebral physiological parameters. The evaluation of recent randomized clinical trials will provide insight into whether a liberal or restrictive transfusion strategy is preferred for this patient population. Hemodynamic and multimodal neurological monitoring to assess cerebral oxygenation, autoregulation, and metabolism are essential tools for detecting early hemodynamic alterations and cerebral injury, guiding resuscitation management, and contributing to improved outcomes.
Keywords: arterial blood pressure; blood transfusion; cerebral perfusion pressure; fluids; fluid management; hemodynamic monitoring; multimodal monitoring; traumatic brain injury arterial blood pressure; blood transfusion; cerebral perfusion pressure; fluids; fluid management; hemodynamic monitoring; multimodal monitoring; traumatic brain injury

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MDPI and ACS Style

Ziaka, M.; Hautz, W.; Exadaktylos, A. A Comprehensive Review of Fluid Resuscitation Strategies in Traumatic Brain Injury. J. Clin. Med. 2025, 14, 6289. https://doi.org/10.3390/jcm14176289

AMA Style

Ziaka M, Hautz W, Exadaktylos A. A Comprehensive Review of Fluid Resuscitation Strategies in Traumatic Brain Injury. Journal of Clinical Medicine. 2025; 14(17):6289. https://doi.org/10.3390/jcm14176289

Chicago/Turabian Style

Ziaka, Mairi, Wolf Hautz, and Aristomenis Exadaktylos. 2025. "A Comprehensive Review of Fluid Resuscitation Strategies in Traumatic Brain Injury" Journal of Clinical Medicine 14, no. 17: 6289. https://doi.org/10.3390/jcm14176289

APA Style

Ziaka, M., Hautz, W., & Exadaktylos, A. (2025). A Comprehensive Review of Fluid Resuscitation Strategies in Traumatic Brain Injury. Journal of Clinical Medicine, 14(17), 6289. https://doi.org/10.3390/jcm14176289

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