Fig. 2
From: Fluid management of the neurological patient: a concise review
Fluid management algorithm as applied in the author’s institution in critically ill SAH patients. Principles underlying the algorithm include: define maintenance fluids (40 ml/kg/day); use isotonic crystalloid fluids; define triggers for more advanced haemodynamic monitoring and define haemodynamic goals, titrate management to these goals and give stopping rules to abort algorithm after improvements. In a subset of high-risk SAH patients, this algorithm resulted in significant reductions in fluid intake whilst maintaining cardiac output and preload indices, thus avoiding hypovolemia [75], in line with a previous study [25]. Both dynamic (e.g. fluid responsiveness) and static (e.g. GEDI) measures of volume status may thus be used to guide fluid administration. SAH subarachnoid haemorrhage, TPT transpulmonary thermodilution-based haemodynamic monitoring, DCI delayed cerebral ischaemia, MAP mean arterial pressure, NS normal saline (0.9 %), CI cardiac index (L/min/m2), GCS Glasgow Coma Scale