Impact of Volemic Support with Balanced Crystalloid Solution on the Predictors of Renal Injury Development in Victims with Severe Traumatic Brain Injury

O.H. Kramareva, L.V. Zhrzheblovska, I.R. Malysh

Abstract


Background. Infusion therapy is an integral part of intensive care in patients with severe traumatic brain injury, but the effectiveness of infusion-transfusion therapy largely depends on the targeted justify of its program, characteristics of infusion solutions, their pharmacological properties and pharmacokinetics. At this stage of intensive care, the choice of solution for volemic support in patients with severe traumatic brain injury remains disputable. Objective: to optimize the technique of volemic support in victims with severe traumatic brain injury in order to reduce the risk of kidney damage and to provide therapy, which is safe in terms of osmolarity. Materials and methods. The study involved 90 patients with severe traumatic brain injury aged 18 to 65 years. The level of consciousness according to the Glasgow Coma Scale at admission and 12 hours after the initial resuscitation — 5–11 points, severity on the APACHE II scale — 21.0 ± 2.7 points. All patients were divided into two groups — control and study one. Victims in the control group received volemic support with 0.9% NaCl solution, by the conventional method. In the study group, volemic support was performed using a balanced crystalloid solution. In both groups, we have measured indicators of sodium, chloride, as well as determined the osmolarity of the blood plasma. Results. According to our study, victims, who received volemic support with a balanced crystalloid solution, had safe indicators of sodium and osmolarity of the blood plasma throughout the whole duration of the study. While in the control group, hyperosmolarity reaches its maximum up to 9th day of treatment. Also, in the study group, there is much less significant hyperchloremia. Conclusions. It was found that the use of a balanced crystalloid solution for volemic support significantly reduced the severity of hypernatremia and hyperchloremia during the first 10 days of treatment, in addition, a balanced crystalloid solution enables to carry out therapy, which is safe in terms of osmolarity.


Keywords


traumatic brain injury; volemic support; osmola­rity of the blood plasma; balanced crystalloid solution

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DOI: https://doi.org/10.22141/2224-0586.4.75.2016.75829

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