Fluid therapy and the use of albumin in the treatment of severe traumatic brain injury

Evidence-based guidelines for severe traumatic brain injury (TBI) do not include strategies for fluid administration. The protocol used in this study includes albumin administration to maintain normal colloid osmotic pressure and advocates a neutral to slightly negative fluid balance. The aim of this study was to analyze the occurrence of organ failure and the mortality in patients with severe TBI treated by a protocol that includes defined strategies for fluid therapy. Ninety-three patients with severe TBI and Glasgow Coma Score <= 8 were included during 1998-2001. Medical records of the first 10 days were retrieved. Organ dysfunction was evaluated with the Sequential Organ Failure Assessment (SOFA) score. Mortality was assessed after 10 and 28 days, 6 and 18 months. The total fluid balance was positive on days 1-3, and negative on days 4-10. The crystalloid balance was negative from day 2. The mean serum albumin was 38 +/- 6 g/l. Colloids constituted 40-60% of the total fluids given per day. Furosemide was administered to 94% of all patients. Severe organ failure defined as SOFA >= 3 was evident only for respiratory failure, which was observed in 29%. None developed renal failure. After 28 days, mortality was 11% and, after 18 months, it was 14%. A protocol including albumin administration in combination with a neutral to a slightly negative fluid balance was associated with low mortality in patients with severe TBI in spite of a relatively high frequency (29%) of respiratory failure, assessed with the SOFA score.