Right off the press: an open access review article from Critical Care on fluid therapy in the neurological patient.
It provides a nice synopsis of the different fluid therapy paradigms that are advocated through various guidelines. The review challenges some of the tenets of basic treatment, such as empirical fluid maintenance and the definition of “euvolemia”. Furthermore, the authors employ a very physiological approach in their reasoning, which I find didactic and helpful. However, it offers relatively little in the way of new insight. Whilst it can be agreed that frank hypovolemia is probably unhelpful in most, if not all, neuropathology, it is hard to envision that we will ever attain a common approach to volume therapy given such a diverse range of conditions.
In all walks of medicine there is increased focus on the dangers of fluid overload. Neurocritical care clinicians are also increasingly cognizant of the potentially detrimental effects it may have on secondary neurological injury. This fact is well conveyed in the article.