Goal-directed fluid therapy combined with dexmedetomidine precipitates neurological outcomes in patients undergoing surgery for traumatic brain injury A randomised controlled trial

Background: Dexmedetomidine is a new type of highly selective α2- adrenergic receptor agonist, which is commonly used in clinical anesthesia. It has been found that dexmedetomidine can protect the brain of patients with traumatic brain injury. At present, there is no report of compound dexmedetomidine for traumatic brain injury patients who receive goal-oriented liquid therapy. This study was to evaluate the effect of goal-directed fluid therapy combined (GDFT) strategy combined with dexmedetomidine on neurological outcomes in patients with traumatic brain injury (TBI) surgery. Methods One hundred-twenty patients with TBI were randomly divided into four groups: control group, GDFT group, dexmedetomidine group and GDFT with dexmedetomidine group. Perioperative transfusion volume and hemodynamics, Glasgow outcome scale (GOS) and postoperative length of hospital stay were recorded. Cerebral oxygen metabolism indexes and biomarkers for brain injury were determined. Results GDFT combined with dexmedetomidine decreased perioperative total transfusion volume including crystalloid and colloidal solution volume than dexmedetomidine group. Combination therapy of GDFT + dexmedetomidine decreased jugular bulb lactate than that at end of the surgery in control group, and had higher SjvO 2 , lower Da-jvO 2 and CERO 2 than that at end of the surgery in GDFT group and dexmedetomidine group. Combination therapy of GDFT + dexmedetomidine decreased serum concentrations of S100β protein and neuron-specific enolase than that at end of the surgery in GDFT group and dexmedetomidine group, and had a higher GOS and a shorter length of hospital stay than the control group. Conclusions Our findings indicate that GDFT combined with dexmedetomidine allows a better-optimized fluid therapy strategy and improves neurological outcomes in patients undergoing surgery for TBI.