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Effect of a fluid bolus on cardiovascular collapse among critically ill adults undergoing tracheal intubation (PrePARE): a randomised controlled trial

2019; Elsevier BV; Volume: 7; Issue: 12 Linguagem: Inglês

10.1016/s2213-2600(19)30246-2

2213-2619

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 D. Caputo, Brent E. Heideman, Aline N. Zouk, Swati Gulati, William S. Stigler, Itay Bentov, Aaron M. Joffe, Todd W. Rice, David R. Janz, Derek J. Vonderhaar, Ross Hoffman, Naveen Turlapati, Sneha D. Samant, Page Clark, Amita Krishnan, Joseph Gresens, Cody Hill, Bobby Matthew, J.C.C. Henry, Jason D. Miller, Rose Paccione, Abdulla Majid-Moosa, Jairo I. Santanilla, Matthew W. Semler, Todd W. Rice, Jonathan D. Casey, Brent E. Heideman, Erin M. Wilfong, Justin C Hewlett, Stephen Halliday, V. Eric Kerchberger, Ryan M. Brown, Luis E. Huerta, Christopher Merrick, Thomas Atwater, Emily G. Kocurek, Andrew C. McKown, Nichelle I. Winters, L. Habegger, Matthew F. Mart, Jeannette Zinggeler Berg, Christina C Noblit, Lisa N. Flemmons, Kevin M. Dischert, Aaron M. Joffe, Itay Bentov, Trefan Archibald, Alejandro Arenas, Camelia Baldridge, Gaurav Bansal, Christopher R. 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 R. Slade, Stuart Solomon, Sarah Stehpey, R. Thompson, David Trausch, Carson Welker, Raymond Zhang, Derek W. Russell, Aline N. Zouk, Swati Gulati, William S. Stigler, Jason Fain, Bryan Garcia, David C. LaFon, Chao He, James V. O’Connor, David L. Campbell, Jordan Powner, Samuel McElwee, Cristina Bardita, K.G. Dsouza, Glauber B. Pereira, Sarah Robinson, Scott Blumhof, James Dargin, Susan Stempek, Joanne Wozniak, 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 S. Patel, Khaled Eissa, Joshua Giacotto, Daniel Fitelson, Michael Colancecco, Anthony Gray, Jason R. West, Nicholas D. Caputo, Mary Ryan, Thomas Parry, Benjamin Azan, Ali Khairat, Renee Morton, David Lewandowski, Carlos Vaca,

Cardiac Arrest and Resuscitation

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 pressure <65 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 pressure <65 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.