Faculty Bibliography

Cerebral autoregulation and the blood-brain barrier are two important mechanisms that attempt to preserve brain homeostasis. The function of either may be disrupted by injury. When autoregulation is impaired, blood pressure and hematocrit determine cerebral oxygen delivery. Injury to the blood-brain barrier impairs brain volume regulation and may contribute to cerebral edema. The choice of intravenous fluid influences cerebral blood flow, cerebral oxygen delivery, brain metabolism, and brain volume

Fluid therapy is a uniformly accepted, logical, and highly effective therapeutic intervention for the treatment of patients with reductions in circulating intravascular volume. This article discusses fluid resuscitation of shock associated with increased vascular permeability and addresses the use of colloids and crystalloids in these disorders

We have attempted to review body fluid distribution by compartments so that the reader understands the physiology of ICF and ECF, and the relationship between interstitial and intravascular fluids. Crystalloids such as NS and RL are distributed to the ECF, whereas colloids primarily remain intravascular for longer periods. Although effective, crystalloids tend to require larger volumes for infusion, and edema remains a problem. Colloids as a group are extremely effective volume expanders, but none is ideal. Albumin, hetastarch, dextran, and the less commonly used colloids each have significant toxicities that must be considered when using them. Intelligent choices can be made to optimize use of these fluids