Comparison of normal saline and balanced crystalloid solution on acid-base and electrolyte balance in emergency neurosurgical trauma patients: A prospective randomised controlled trial

• Author Details:   
• Ambuj Giri
• Yashpal Singh
• Sarita Kumari ^*
• Devesh Shukla
• Priyanka Dwivedi
• Ravi Shanker Prashad
• Saurabh Sagar
• Navneeta Bisht
• Indresh Yadav

---

Background: Maintaining cerebral perfusion, controlling brain volume, and providing adequate substrate delivery are the goals of fluid therapy in patients with Traumatic Brain Injury (TBI). While Normal Saline (NS) is frequently used, Balanced Crystalloid Solutions (BCS) like Plasmalyte (PL) offer potential benefits due to their electrolyte composition and decreased risk of hyperchloremic acidosis. This study compares the effects of NS versus BCS on acid-base and electrolyte status in emergency neurosurgical trauma patients.

Materials and Methods: A prospective, randomised, double-blinded study was conducted at a tertiary care trauma centre October 2020 to September 2021. One hundred TBI patients undergoing decompressive craniotomy were randomly assigned to receive either NS (Group N) or BCS (Group B) as maintenance fluids. Fluid management was guided by intraoperative needs and arterial blood gases, electrolytes, and urine output were measured pre-operatively, immediately post-operatively, and 6 hours post-operatively. Statistical analysis included ANOVA, paired t-tests, and un-paired t-tests, with a significance level set at p < 0>

Results: Demographic characteristics and Glasgow Coma Scale (GCS) scores were comparable between groups. Post-operatively, patients in Group B showed a significantly higher pH (7.42 vs. 7.39, p = 0.02) and more stable bicarbonate levels compared to Group N. Lactate levels were closer to normal in Group B. Sodium and chloride levels were higher in Group N, while potassium and calcium levels were more stable in Group B. Urine output was significantly greater in Group B (1341.40 ± 232.70 mL) compared to Group N (1091.0 ± 253.45 mL, p < 0>

Conclusion: Balanced Crystalloid Solutions as maintenance fluids during the peri-operative period in traumatic brain injury patients result in less electrolyte and acid-base disturbance compared to Normal Saline. However, this did not translate into improved survival outcomes. Further research is needed to confirm these findings and assess long-term impacts on patient recovery.

Keywords: Normal saline (NS), Balanced salt solution (BSS), Trauma patients, Neurosurgical patients, Electrolyte, Acid base.