Effects on Brain Edema of Crystalloid and Albumin Fluid Resuscitation after Brain Trauma and Hemorrhage in the Rat

• Published in: Anesthesiology (Philadelphia) Vol. 112; no. 5; pp. 1194 - 1203
• Main Authors: Jungner, Mårten, Grände, Per-Olof, Mattiasson, Gustav, Bentzer, Peter
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.05.2010
• Subjects: Albumins - administration & dosage; Albumins - adverse effects; Anestesi och intensivvård; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology and Intensive Care; Animals; Biological and medical sciences; Blood Volume - physiology; Brain Edema - chemically induced; Brain Edema - drug therapy; Brain Edema - physiopathology; Brain Injuries - complications; Brain Injuries - drug therapy; Brain Injuries - physiopathology; Cerebral Hemorrhage - complications; Cerebral Hemorrhage - drug therapy; Cerebral Hemorrhage - physiopathology; Clinical Medicine; Isotonic Solutions - administration & dosage; Isotonic Solutions - adverse effects; Klinisk medicin; Male; Medical and Health Sciences; Medical sciences; Medicin och hälsovetenskap; Rats; Rats, Sprague-Dawley; Resuscitation - adverse effects; Nervous system diseases; Rat; Rodentia; Albumin; Hemorrhage; Trauma; Cerebral disorder; Encephalon; Vertebrata; Mammalia; Animal; Central nervous system disease; Anesthesia; Cerebral edema; Resuscitation
• DOI: 10.1097/ALN.0b013e3181d94d6e
• ISSN: 0003-3022; 1528-1175

It has been hypothesized that resuscitation with crystalloids after brain trauma increases brain edema compared with colloids, but previous studies on the subject have been inconclusive. To test this hypothesis, the authors compared groups resuscitated with either colloid or crystalloid. After fluid percussion injury, rats were subjected to a controlled hemorrhage of 20 ml/kg and were randomized to 5% albumin at 20 ml/kg (A20), isotonic Ringer's acetate at 50 ml/kg (C50), or 90 ml/kg (C90). After 3 or 24 h, water content in the injured cortex was determined using a wet/dry weight method. Blood volume was calculated from plasma volume, measured by 125I-albumin dilution, and hematocrit. Oncotic pressure and osmolality were measured with osmometers. At 3 h, blood volume was equal in the A20 and C90 groups and lower in the C50 group. Oncotic pressure was reduced by 35-40% in the crystalloid groups and unchanged in the albumin group. Cortical water content in the A20 group was lower than in the C90 group (81.3 +/- 0.5% vs. 82.1 +/- 1.1%, P < 0.05), but it was not different from the C50 group (81.8 +/- 1.1%). At 24 h, oncotic pressure and blood volume were normalized in all groups, and cortical water content was significantly lower in the albumin group than in the crystalloid groups. Osmolality and arterial pressure were equal in all groups throughout the experiment. When given to the same intravascular volume expansion, isotonic crystalloids caused greater posttraumatic brain edema than 5% albumin at 3 and 24 h after trauma.