Comparison of fluid bolus and fluid bolus plus low dose noradrenaline infusion on cardiovascular collapse among critically ill adults before tracheal intubation: a randomized trial

Abstract

Background:Endotracheal intubation of critically ill patients is associated with various complications, mainly hypotension. The administration of an intravenous fluid bolus before induction of anesthesia has been used to prevent hypotension during endotracheal intubation in the intensive care unit (ICU). However, some patients still experience hemodynamic instability. Therefore, this study was conducted to compare the effect of a fluid bolus alone and a fluid bolus plus low-dose noradrenaline infusion on cardiovascular collapse among critically ill adults before tracheal intubation.

Methods:The randomized trial enrolled 136 critically ill patients who required endotracheal intubation. Patients were allocated to the intravenous fluid (group A) and the intravenous fluid plus low-dose noradrenaline group (group B). Cardiovascular collapse, hypotension, and other secondary outcomes were recorded.

Results:Vasopressor requirement at 2 minutes postinduction was lower in group B (39.7%) than in group A (44.1%). Cardiac arrest within 1 hour occurred in 2.9% of patients in group A. Death within 1 hour occurred in 2.9% patients of group A and 1.5% of group B. The requirement for renal replacement therapy, duration of vasopressor requirement and inhospital mortality were higher in group B. The duration of ICU stay and the duration of ventilator requirement were higher in group A. All these differences were statistically insignificant except for the total duration of hospital stay, which was longer in group A than in group B (P = 0.036).

Conclusion:Among critically ill patients undergoing tracheal intubation, the administration of intravenous fluid bolus plus low-dose noradrenaline, compared with a fluid bolus alone, did not significantly reduce the incidence of cardiovascular collapse.

Keywords

Cardiovascular collapse / Critically ill patients / Endotracheal intubation / Fluid bolus / Low-dose noradrenaline

Conflict of interest statement

The authors declare no conflict of interest.

Author contributions

Jahan SM contributed to concept and design of study; acquisition, analysis, and interpretation of data; drafting the manuscript; and final approval of the version to be published. Dubey M contributed to concept and design of study; acquisition, analysis, and interpretation of data; manuscript preparation, manuscript editing and review, and final approval of the version to be published. Mustahsin M contributed to concept of study, data interpretation, manuscript preparation, manuscript review, and final approval of the version to be published. Choubey S contributed to concept of study, manuscript editing, manuscript review, and final approval of the version to be published. Singh S contributed to data interpretation, manuscript review, and final approval of the version to be published. Amir M contributed to Data interpretation, manuscript editing and review, and final approval of the version to be published.

Funding

None.

Ethical approval of studies and informed consent

The study followed the principles of the Declaration of Helsinki as revised in 2013. This study was approved by the Institutional Ethics Committee of Era University (reference number: ELMC&H/R-Cell/2023/37 on February 28, 2023), and written informed consent was obtained from the patient or their next kin. The trial was registered with Clinical Trials Registry-India (CTRI number: CTRI/2023/07/054773, URL: https://ctri.nic.in/Clinicaltrials/main1.php?EncHid=99458.25924, date of registry: July 5, 2023). Written informed consent was obtained from all individual participants or their next kin included in the study.

Acknowledgments

None.

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