Choice of Infusion Media for Microcirculatory Disorders Correction in Severe Traumatic Brain Injury

T.O. Tokmakova, Ye.V. Grigoryev, Ye.A. Kameneva, S.Yu. Permyakova, Yu.A. Churlyaev

Abstract


The objective of the investigation — to provide a rationale for the choice of infusion media in order to correct microcirculatory disorders in victims with severe traumatic brain injury. Patients were divided into 4 groups. In group 1 (n = 21) infusion therapy consisted of modified gelatin in a daily dose of 7 ml/kg body weight, in group 2 (n = 19) — balanced crystalloid solution in a dose of 6.5 ml/kg body weight, in group 3 (n = 19) — 6% solution of hydroxyethyl starch 130/0.4 in a dose of 6 ml/kg body weight, and in group 4 (n = 21) — 0.9% sodium chloride solution in a daily dosage of 14 ml/kg body weight.
In addition to general clinical studies, all patients underwent monitoring of central hemodynamics and evaluation of microcirculation by laser Doppler flowmetry. As a result, the need for correction of microcirculation in all patients with severe traumatic brain injury has been proved.
Inclusion in the algorithm of physicians’ work of methods for microcirculation control (parameter of laser Doppler flowmetry) facilitates the selection of infusion media.
Hydroxyethyl starch 130/0.4 has the best combination of properties for the correction of microcirculation. Less effective are the drugs of modified gelatin. Balanced and unbalanced crystalloids do not contribute to the restoration of microcirculatory blood flow.


Keywords


severe traumatic brain injury; microcirculatory disorders; choice of infusion media

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DOI: https://doi.org/10.22141/2224-0586.8.63.2014.84214

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