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.
Jahan et al. (Tue,) studied this question.