ABSTRACT
The optimal fluid management approach for patients with neurotrauma has been widely debated, particularly with regard to the choice, amount, and timing of fluid administration. Patients with brain and spinal injuries present specific challenges to the anesthesiologist, and it is crucial that the risks associated with excessive fluid administration are balanced against the risks of hypovolemia-associated cerebral and/or spinal hypoperfusion resulting from restrictive fluid administration practices. The aim of this chapter is to provide a brief overview of the physiology of sodium and water homeostasis, describe the main methods of monitoring and management fluid status, and review the evidence for specific fluid management approaches. Additionally, some specific challenges in the fluid management of neurotrauma patients are discussed, including prehospital fluid resuscitation protocols, management of intracranial hypertension, and management of spinal cord injury.
