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BIRMINGHAM – An intravenous bolus of fluids does not appear to protect critically ill patients undergoing endotracheal intubation in the ICU from cardiovascular collapse. This is the result of a randomized study with over 1,000 patients from the USA, the results of which are published in JAMA have been published (2022; DOI: 10.1001 / jama.2022.9792).
“Endotracheal intubation of critically ill patients often causes circulatory failure due to insufficient perfusion, increasing the risk of cardiac arrest and death,” said lead author Derek W. Russell of the Division of Pulmonary, Allergic and Critical Medicine Alabama of the University of UC Heersink School of Medicine in Birmingham and its co-authors.
It was unclear whether intravenous administration of a liquid bolus could prevent severe hypotension, cardiac arrest and death.
The clinical study enrolled 1,067 critically ill adults in 11 US intensive care units. They were endotracheally intubated under sedation and positive pressure ventilation. They were randomized to receive either 500 mL of intravenous fluids (538 patients) or no fluid bolus (527 patients).
Examined for severe hypertension, cardiac arrest, or death
The occurrence of cardiovascular collapse was examined as a primary endpoint. This was defined as treatment with vasopressors or systolic pressure <65 mmHg between induction of anesthesia and 2 minutes after intubation, or cardiac arrest or death between induction of anesthesia and 1 hour after intubation.
The secondary endpoint of the study was the incidence of death in the first 28 days after intubation or until hospital discharge. A total of 1,065 patients were included in the primary analysis. They had an average of 62 years, 42% were women.
No significant differences between the groups
Cardiovascular collapse occurred in 113 patients (21.0%) in the fluid bolus group and 96 patients (18.2%) in the no fluid bolus group. The absolute difference between the two groups was 2.8% (95% CI -2.2 to 7.7) and was not statistically significant (p = 0.25).
Vasopressor treatment occurred in 20.6% of patients in the liquid bolus group and in 17.6% of patients in the non-liquid bolus group.
Systolic blood pressure below 65 mmHg occurred in 3.9% versus 4.2% and cardiac arrest in 1.7% versus 1.5%. In the group with the liquid bolus, 0.7% of patients died, compared with 0.6% in the group without the liquid bolus.
There was no difference between the two groups even with regard to the secondary endpoint: 218 patients (40.5%) died within 28 days in the liquid bolus group and 223 patients (42.3%) in the non-liquid bolus group. . Again, the absolute difference of -1.8% (95% CI -7.9 to 4.3) was not statistically significant (p = 0.55). © nca / aerzteblatt.de