Skip to content
DraconiticResearch
Search Sources API
203,948 studies31 sourcesUpdated 33 min ago
Peer-reviewedCC BY 4.0Journal of Clinical Medicine

Fluid Management in Patients with Concomitant Acute Brain Injury and ARDS

  • Esenia Bechir1
  • Aristomenis Exadaktylos2,3
  • Wolf Hautz1
  • Mairi Ziaka1,3
  1. 1Department of Emergency Medicine, Inselspital, University Hospital, University of Bern, 3010 Bern, Switzerland
  2. 2Academic Department of Emergency Medicine, School of Medicine, University of Cyprus, 1678 Nicosia, Cyprus
  3. 3Service des Urgences-SMUR, Fribourg Cantonal Hospital (HFR), 1708 Fribourg, Switzerland
Open at sourceDOICite

Abstract

The main goals of therapeutic management in patients with acute brain injury (ABI) are to maintain cerebral perfusion pressure (CPP), promote cerebral oxygenation, reduce cerebral edema, prevent intracranial hypertension, and minimize acute neuronal injury in order to limit secondary brain damage. In this context, fluid management is of vital importance, as hypotension and hypovolemia are common in patients with ABI, predisposing them to secondary injury and poorer outcomes, and often necessitating a more liberal fluid strategy. On the other hand, ABI frequently leads to lung injury (LI), including neurogenic pulmonary edema (NPE) and acute respiratory distress syndrome (ARDS), which typically require a conservative fluid strategy to limit pulmonary edema, thereby making fluid resuscitation a significant clinical challenge. Hypervolemia and fluid overload are associated with serious complications, including worsening cerebral edema, delayed ischemic deficits, hemorrhagic diathesis, congestive heart failure, and pulmonary edema. Evidence to guide fluid management strategies in patients with concomitant ABI and ARDS remains limited. Current guidelines recommend targeting normovolemia in patients with ABI using a multimodal approach, with primary endpoints such as arterial blood pressure and fluid balance, while avoiding a negative fluid balance. In these patients, an individualized fluid therapy based on hemodynamic and clinical parameters, as well as cerebral dynamics, is recommended, taking into account the disease course and the potential ARDS subphenotypes.

Related

  1. Functional Trajectories Following Clinically Selected Management of Concomitant Proximal Humerus Fractures in Geriatric Hip-Fracture Patients: A Retrospective Cohort Study
    Borja Lara-Galdón, José María Hernández-Mateo, Lourdes Prats-Peinado +5
    Journal of Clinical MedicinePeer-reviewedCC BY 4.0Surgery & anaesthesiaCrossref
  2. Cardiac Surgery-Associated Acute Kidney Injury: A Continuum from Pathophysiological Mechanisms to Prevention, Management, and Long-Term Care : Short title: Cardiac Surgery-Associated Acute Kidney Injury.
    Sohrab Negargar, Elnaz Javanshir, Sahar Sadeghi
    Galen medical journalPeer-reviewedCC BYFull textGeneral medicineEurope PMC
  3. Association of pretransfusion platelet count with mortality in patients with sepsis-associated acute kidney injury
    Zhishun Ye, Yijian Li, Yongqiang Lao +1
    Scientific ReportsPeer-reviewedCC BY-NC-ND 4.0Full textGeneral medicineCrossref
  4. Clinical practice guideline for renal replacement therapy in critically ill patients with acute kidney injury (2026 edition)
    Yan Kang, Xiangdong Guan, Dechang Chen
    Journal of intensive medicinePeer-reviewedCC BY-NC-NDFull textGeneral medicineEurope PMC
  5. Acute Kidney Injury in Childhood Nephrotic Syndrome: From Hemodynamic Vulnerability and Tubular Stress Toward Biomarker-Guided Management.
    John Dotis, Nikoleta Printza
    Medicina (Kaunas, Lithuania)Peer-reviewedCC BYFull textGeneral medicineEurope PMC

Cite

BibTeXRIS
BibTeX
@article{bechir2026fluid,
  title = {{Fluid Management in Patients with Concomitant Acute Brain Injury and ARDS}},
  author = {Esenia Bechir and Aristomenis Exadaktylos and Wolf Hautz and Mairi Ziaka},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = nov,
  doi = {10.3390/jcm15218675},
  url = {https://www.mdpi.com/2077-0383/15/21/8675},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Fluid Management in Patients with Concomitant Acute Brain Injury and ARDS
AU  - Esenia Bechir
AU  - Aristomenis Exadaktylos
AU  - Wolf Hautz
AU  - Mairi Ziaka
PY  - 2026
DA  - 2026/11/06
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15218675
UR  - https://www.mdpi.com/2077-0383/15/21/8675
AB  - The main goals of therapeutic management in patients with acute brain injury (ABI) are to maintain cerebral perfusion pressure (CPP), promote cerebral oxygenation, reduce cerebral edema, prevent intracranial hypertension, and minimize acute neuronal injury in order to limit secondary brain damage. In this context, fluid management is of vital importance, as hypotension and hypovolemia are common in patients with ABI, predisposing them to secondary injury and poorer outcomes, and often necessitating a more liberal fluid strategy. On the other hand, ABI frequently leads to lung injury (LI), including neurogenic pulmonary edema (NPE) and acute respiratory distress syndrome (ARDS), which typically require a conservative fluid strategy to limit pulmonary edema, thereby making fluid resuscitation a significant clinical challenge. Hypervolemia and fluid overload are associated with serious complications, including worsening cerebral edema, delayed ischemic deficits, hemorrhagic diathesis, congestive heart failure, and pulmonary edema. Evidence to guide fluid management strategies in patients with concomitant ABI and ARDS remains limited. Current guidelines recommend targeting normovolemia in patients with ABI using a multimodal approach, with primary endpoints such as arterial blood pressure and fluid balance, while avoiding a negative fluid balance. In these patients, an individualized fluid therapy based on hemodynamic and clinical parameters, as well as cerebral dynamics, is recommended, taking into account the disease course and the potential ARDS subphenotypes.
SN  - 2077-0383
ER  -