June 16, 2022
Effect of Fluid Bolus Administration on Cardiovascular Collapse Among Critically Ill Patients Undergoing Tracheal Intubation.
What was the research question?
Does the administration of a fluid bolus prevent the incidence of vascular collapse in patients undergoing endotracheal intubation?
How did they do it?
An international, randomized trial at 11 ICUs in the US.
1065 patients undergoing endotracheal intubation, were randomized to receive either a 500-mL intravenous fluid bolus of isotonic crystalloid solution (n = 538) or no fluid bolus (n = 527).
The primary outcome was incidence of vascular collapse defined as new or increased receipt of vasopressors or a systolic blood pressure <65 mm Hg, or cardiac arrest, or death between induction of anesthesia and 2 minutes after tracheal intubation.
Secondary outcome was 28-day mortality.
What did they find?
Median age was 62 years [IQR, 51-70 years]; and 42.1% were women.
Cardiovascular collapse incidence was not significantly different in the fluid bolus group compared to the no fluid bolus group (21.0% vs. 18.2%, absolute difference, 2.8% [95% CI, −2.2% to 7.7%]; P = .25).
There was no significant difference in the incidence of a new or increased receipt of vasopressors (20.6% vs.17.6%), a systolic blood pressure of less than 65 mm Hg (3.9% vs. 4.2%), cardiac arrest (1.7% vs. 1.5%), or death (0.7% vs. 0.6%).
28-day mortality was not significantly different between the two groups (40.5% in the fluid bolus group compared with 42.3% in the no fluid bolus group, absolute difference, −1.8% [95% CI, −7.9% to 4.3%]; P = .55).
Are there any limitations?
Not blinded with potential of bias.
15% of patients who were screened, were not included due to urgency of procedure.
Does not exclude the benefit of larger volume of fluid.
The trial used a composite outcome and the administration of new or increased vasopressor accounted for the majority of outcome and it is not patient-centered outcome.
The assumed difference of 7% in the 90-day mortality may have been large to detect statistical difference.
What does it mean?
Fluid bolus administration prior to endotracheal intubation does not prevent the occurrence of vascular collapse.