1. Effect of a fluid bolus on cardiovascular collapse among critically ill adults undergoing tracheal intubation (PrePARE): a randomised controlled trial
- Author
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David R Janz, Jonathan D Casey, Matthew W Semler, Derek W Russell, James Dargin, Derek J Vonderhaar, Kevin M Dischert, Jason R West, Susan Stempek, Joanne Wozniak, Nicholas Caputo, Brent E Heideman, Aline N Zouk, Swati Gulati, William S Stigler, Itay Bentov, Aaron M Joffe, Todd W Rice, Ross Hoffman, Naveen Turlapati, Sneha Samant, Page Clark, Amita Krishnan, Joseph Gresens, Cody Hill, Bobby Matthew, Jason Henry, Jason Miller, Rose Paccione, Abdulla Majid-Moosa, Jairo I Santanilla, Erin M Wilfong, Justin C Hewlett, Stephen J Halliday, V Eric Kerchberger, Ryan M Brown, Luis E Huerta, Christopher M Merrick, Thomas Atwater, Emily G Kocurek, Andrew C McKown, Nichelle I Winters, Luke E Habegger, Matthew F Mart, Jeannette Z Berg, Christina C Noblit, Lisa N Flemmons, Kevin Dischert, Aaron Joffe, Trefan Archibald, Alejandro Arenas, Camelia Baldridge, Gaurav Bansal, Christopher Barnes, Nicholas Bishop, Beth Bryce, Laura Byrne, Rachel Clement, Carla DeLaCruz, Priya Deshpande, Zi Gong, John Green, Austin Henry, Andrew Herstein, Jessica Huang, Jake Heier, Bonnie Jenson, Lynn Johnston, Cara Langeland, Calvin Lee, Alex Nowlin, Travis Reece-Nguyen, Hunter Schultz, Graeme Segal, Ian Slade, Stuart Solomon, Sarah Stehpey, Robin Thompson, David Trausch, Carson Welker, Raymond Zhang, Derek Russell, Aline Zouk, William Stigler, Jason Fain, Bryan Garcia, David Lafon, Chao He, James O'Connor, David Campbell, Jordan Powner, Samuel McElwee, Cristina Bardita, Kevin D'Souza, G Bruno Pereira, Sarah Robinson, Scott Blumhof, Piyanuch Pataramekin, Dhruv Desai, Ekaterina Yayarovich, Robert DeMatteo, Sandeep Somalaraiu, Christopher Adler, Courtney Reid, Michael Plourde, Jordan Winnicki, Timothy Noland, Tamar Geva, Lee Gazourian, Avignat Patel, Khaled Eissa, Joshua Giacotto, Daniel Fitelson, Michael Colancecco, Anthony Gray, Mary Ryan, Thomas Parry, Benjamin Azan, Ali Khairat, Renee Morton, David Lewandowski, and Carlos Vaca
- Subjects
Pulmonary and Respiratory Medicine ,Male ,medicine.medical_treatment ,Critical Illness ,Population ,law.invention ,Bolus (medicine) ,Randomized controlled trial ,law ,Intubation, Intratracheal ,Medicine ,Intubation ,Humans ,Vasoconstrictor Agents ,education ,Infusions, Intravenous ,Aged ,education.field_of_study ,business.industry ,Critically ill ,Tracheal intubation ,Shock ,Emergency department ,Crystalloid Solutions ,Middle Aged ,Respiration, Artificial ,Blood pressure ,Anesthesia ,Fluid Therapy ,Female ,business - Abstract
Tracheal intubation is common in the care of critically ill adults and is frequently complicated by hypotension, cardiac arrest, or death. We aimed to evaluate administration of an intravenous fluid bolus to prevent cardiovascular collapse during intubation of critically ill adults.We did a pragmatic, multicentre, unblinded, randomised trial in nine sites (eight ICUs and one emergency department) around the USA. Critically ill adults (≥18 years) undergoing tracheal intubation were randomly assigned (1:1, block sizes of 2, 4, and 6, stratified by study site) to either an intravenous infusion of 500 mL of crystalloid solution or no fluid bolus. The primary outcome, assessed in the intention-to-treat population, was cardiovascular collapse, defined as a new systolic blood pressure65 mm Hg; new or increased vasopressor receipt between induction and 2 min after tracheal intubation; or cardiac arrest or death within 1 h of tracheal intubation. Adverse events were assessed in the as-treated population. This trial, which is now complete, is registered with ClinicalTrials.gov, number NCT03026777.Patients were enrolled from Feb 6, 2017, to Jan 9, 2018, when the data and safety monitoring board stopped the trial on the basis of futility. By trial termination, 337 (63%) of 537 screened adults had been randomly assigned. Cardiovascular collapse occurred in 33 (20%) of 168 patients in the fluid bolus group compared with 31 (18%) of 169 patients in the no fluid bolus group (absolute difference 1·3% [95% CI -7·1% to 9·7%]; p=0·76). The individual components of the cardiovascular collapse composite outcome did not differ between groups (new systolic blood pressure65 mm Hg 11 [7%] in the bolus group vs ten [6%] in the no-bolus group, new or increased vasopressor 32 [19%] vs 31 [18%], cardiac arrest within 1 h seven [4%] vs two [1%], death within 1 h of intubation two [1%] vs one [1%]). In-hospital mortality was not significantly different in the fluid bolus group (48 [29%]) compared with no fluid bolus (59 [35%]).Administration of an intravenous fluid bolus did not decrease the overall incidence of cardiovascular collapse during tracheal intubation of critically ill adults compared with no fluid bolus in this trial.US National Institutes of Health.
- Published
- 2019