IV fluid bolus fails to prevent cardiovascular collapse in intubated patients: JAMA

USA: Application of an intravenous (IV) fluid bolus did not substantially reduce the risk of cardiovascular collapse in critically sick people undergoing tracheal intubation, says an article published in the Journal of American Medical Association.

During tracheal intubation of critically sick individuals, hypotension is widespread, increasing the risk of cardiac arrest and mortality. It is unclear if giving an intravenous fluid bolus to severely unwell individuals undergoing tracheal intubation reduces severe hypotension, cardiac arrest, or death. As a result, Derek W. Russell and colleagues undertook this study to see how fluid bolus delivery affected the incidence of severe hypotension, cardiac arrest, and mortality.

Between February 1, 2019, and May 24, 2021, 1067 critically sick patients had tracheal intubation with sedation and positive pressure ventilation at 11 intensive care units in the United States. The last follow-up was scheduled for June 21, 2021. Patients were randomized at random to receive a 500-mL intravenous fluid bolus (n = 538) or no fluid bolus (n = 527). The main result was cardiovascular collapse. The incidence of mortality prior to day 28, which was censored at hospital release, was the secondary outcome.

The key findings of this study were as follow:

1. 1065 (99.8%) of the 1067 participants randomly completed the experiment and were included in the main analysis.

2. Cardiovascular collapse occurred in 113 (21.0%) of the fluid bolus patients and 96 (18.2%) of the no fluid bolus patients.

3. Vasopressors were given to 20.6% of patients in the fluid bolus group compared to 17.6% of patients in the no fluid bolus group, systolic blood pressure was less than 65 mm Hg in 3.9% vs 4.2%, cardiac arrest occurred in 1.7% vs 1.5%, and death occurred in 0.7% vs 0.6%.

4. Death occurred in 218 patients (40.5%) in the fluid bolus group and 223 patients (42.3%) in the no fluid bolus group before day 28.

In conclusion, the findings of this study did not highlight any significant effect of intravenous fluid bolus for cardiovascular risk reduction. 

Reference:

Russell, D. W., Casey, J. D., Gibbs, K. W., Ghamande, S., Dargin, J. M., Vonderhaar, D. J., Joffe, A. M., Khan, A., Prekker, M. E., Brewer, J. M., Dutta, S., Landsperger, J. S., … Arroliga, A. C. (2022). Effect of Fluid Bolus Administration on Cardiovascular Collapse Among Critically Ill Patients Undergoing Tracheal Intubation. In JAMA. American Medical Association (AMA). https://doi.org/10.1001/jama.2022.9792