Fluid bolus before intubation

Here’s the scenario. You’re about to intubate a patient. We know that a percentage, somewhere up to 25% will drop their blood pressure, some may even have a cardiac arrest(1).

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.

Question Asked

Does a fluid bolus, before induction, affect the rate of cardiovascular collapse during intubation?

Study Design

Multicentre randomised trial, unblinded.

Outcomes

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

Results

n =337 – about half received fluid and half didn’t

No significant difference between the two groups. Study stopped prematurely due to futility.

 

References

  1. Umobong EU et al. Critical Care Airway Management. Crit Care Clinic 2018;34:313-24 pubmed
  2. 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