Fluid bolus before intubation
Here’s the scenario. You’re about to intubate a patient.
I usually, instinctively almost, ask for a bag of fluid to be hung, if not already up and give a bolus. Does it make a difference?
This study by Janz et al(2) found that an IV bolus, of 500mL of crystalloid, made no difference.
Does a fluid bolus, before induction, affect the rate of cardiovascular collapse during intubation?
Multicentre randomised trial, unblinded.
Cardiovascular collapse, which was defined as:
- Systolic Blood Pressure < 65mmHg
- Increased pressor use between induction and 2 minutes after intubation
- Cardiac arrest or death within 1 hour of intubation
n =337 – about half received fluid and half didn’t
No significant difference between the two groups. Study stopped prematurely due to futility.
- Umobong EU et al. Critical Care Airway Management. Crit Care Clinic 2018;34:313-24 pubmed
- Janz DR et al. Effect of Fluid Bolus on cardiovascular collapse among critically ill adults undergoing tracheal intubation (PrePARE): a randomised control trial. Lancet Resp Med 2019 Dec;7(12):1039-1047. pubmed