Why are we still arguing about the best way to give fluids to patients with traumatic brain injury (TBI)? 🤔 This seems like a basic question, but the answer is complex and could mean the difference between life and death at the bedside.

A recent comprehensive review article from the Journal of Clinical Medicine dives deep into the clinical and physiological challenges of fluid resuscitation in TBI patients. The authors conducted a non-systematic literature review of studies over the last two decades, focusing on fluid management, types of fluids, and transfusion strategies. The research highlights a critical paradox: while hypotension (low blood pressure) is a known killer in TBI, giving too much fluid can be just as deadly by worsening cerebral edema.                  

The key takeaway? There is no one-size-fits-all approach. For fluid choice, the review argues against using balanced crystalloids like Ringer's lactate, suggesting they could worsen cerebral edema due to their relative hypotonicity. Instead, normal saline is often the preferred first-line fluid . As for blood transfusions, the data is contradictory. While some studies suggest a liberal transfusion strategy (aiming for a higher hemoglobin target) improves outcomes, others found no benefit and even a higher risk of adverse events    . This means that transfusion decisions should be highly individualized, based on the patient's specific physiological parameters, not a fixed number    . 

This research is a wake-up call for frontline clinicians. It reminds us that blindly following protocols can be harmful. Every fluid bag, every pressor drip, and every unit of blood must be a thoughtful, personalized decision guided by robust

hemodynamic and neuromonitoring . 

Want to know how to make smarter, more precise fluid decisions for your TBI patients? Tune in to this episode as we break down the latest evidence and translate it into actionable steps for your daily practice.