PREPARE II
Trial question
What is the effect of fluid bolus administration in critically ill adults undergoing tracheal intubation?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
42.0% female
58.0% male
N = 1065
1065 patients (448 female, 617 male).
Inclusion criteria: critically ill adult patients undergoing tracheal intubation with sedation and positive pressure ventilation.
Key exclusion criteria: immediate need for tracheal intubation precluding randomization; indication or contraindication for fluid bolus administration.
Interventions
N=538 fluid bolus (500 mL intravenous infusion of isotonic crystalloid solution of the clinician's choice).
N=527 no fluid bolus (initiation of a new intravenous fluid bolus not permitted except as treatment for hypotension).
Primary outcome
Cardiovascular collapse
21%
18.2%
21.0 %
15.8 %
10.5 %
5.3 %
0.0 %
Fluid
bolus
No fluid
bolus
No significant
difference ↔
No significant difference in cardiovascular collapse (21% vs. 18.2%; AD 2.8%, 95% CI -2.2 to 7.7).
Secondary outcomes
No significant difference in the rate of death prior to day 28 (40.5% vs. 42.3%; ARD -1.8, 95% CI -7.9 to 4.3).
No significant difference in severe hypoxemia (14.9% vs. 13.7%; AD 1.2%, 95% CI -3.3 to 5.6).
No significant difference in median invasive mechanical ventilation-free days through day 28 (14 days vs. 12 days; MD 2, 95% CI -10 to 15).
Conclusion
In critically ill adult patients undergoing tracheal intubation with sedation and positive pressure ventilation, fluid bolus was not superior to no fluid bolus with respect to cardiovascular collapse.
Reference
Derek W Russell, Jonathan D Casey, Kevin W Gibbs et al. Effect of Fluid Bolus Administration on Cardiovascular Collapse Among Critically Ill Patients Undergoing Tracheal Intubation: A Randomized Clinical Trial. JAMA. 2022 Jul 19;328(3):270-279.
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