As expected, this randomized, double-blind, single center study showed a significant decrease of hyperchloremic metabolic acidosis in patients with brain injury (brain trauma with CGS ≤ 8 or subarachnoid haemorrhage with World Federation of Neurosurgical Society ≥ grade III) treated with balanced solutions compared to chloride-rich solutions in the first 48 hours of ICU admission.

Regrettably, as reported by the authors in the study limitations, the number of patients was too small to investigate the potential effects of this therapy on intracranial pressure. Indeed, if hyperchloremic acidosis can have systemic side effects, the effect on intracranial pressure is most important in brain trauma. Only studies on a larger scale will be able to answer this question before one decides to change the type of solutions for fluid resuscitation (balanced or chloride-rich) in brain trauma patients.
– Michael Piagnerelli