Positive Fluid Balance
A positive fluid balance indicates that the patient's fluid input is higher than their output.
In critically ill patients with traumatic brain injury, there is significant variability in fluid management, with more positive fluid balances being associated with worse outcomes. These results, when added to previous evidence, suggest that aiming for neutral fluid balances, indicating a state of normovolemia, contributes to improved outcome 1).
Restrictive fluid management can reduce cerebral edema and improve the prognosis but does not affect the 28-day mortality of patients with sTBI 2)
Greater positive net fluid balance is independently associated with poorer functional outcome in patients with aSAH 3).
1)
Wiegers EJA, Lingsma HF, Huijben JA, Cooper DJ, Citerio G, Frisvold S, Helbok R, Maas AIR, Menon DK, Moore EM, Stocchetti N, Dippel DW, Steyerberg EW, van der Jagt M; CENTER-TBI; OzENTER-TBI Collaboration Groups. Fluid balance and outcome in critically ill patients with traumatic brain injury (CENTER-TBI and OzENTER-TBI): a prospective, multicentre, comparative effectiveness study. Lancet Neurol. 2021 Aug;20(8):627-638. doi: 10.1016/S1474-4422(21)00162-9. PMID: 34302787.
2)
Zhao S, Xu D, Li R, Zou Q, Chen Z, Wang H, He X. [Clinical efficacy of restrictive fluid management in patients with severe traumatic brain injury]. Nan Fang Yi Ke Da Xue Xue Bao. 2021 Jan 30;41(1):111-115. Chinese. doi: 10.12122/j.issn.1673-4254.2021.01.16. PMID: 33509762; PMCID: PMC7867488.
3)
Kissoon NR, Mandrekar JN, Fugate JE, Lanzino G, Wijdicks EF, Rabinstein AA. Positive Fluid Balance Is Associated With Poor Outcomes in Subarachnoid Hemorrhage. J Stroke Cerebrovasc Dis. 2015 Oct;24(10):2245-51. doi: 10.1016/j.jstrokecerebrovasdis.2015.05.027. Epub 2015 Aug 13. PMID: 26277290.