NEXTGEN LEARNING DESIGNED TO ELEVATE YOUR AIRWAY PRACTICE
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assess Need
Is your hypotensive patient fluid responsive? Unless they are clearly volume overloaded don’t forget to give fluids to support a MAP over 70mmHg prior to intubation.
- Start with 1-2 Liters of NS or LR
- Goal of MAP >70 mmHg
- Prior to intubation.
News Update: normal saline is just fine (didn’t we already know that?) Don’t let anyone tell you otherwise.
what to give
Balanced fluids or normal saline. We can finally end this debate. The BaSICS trial can put your mind at rest on this one. This BOTTOM LINE of a great review from Justing Morgenstern sums it up.
“This is the best and largest study of normal saline and balanced IV fluids to date, and it is pretty clear that normal saline is as safe as the balanced fluid. (Whether providing either IV fluid to these patients is beneficial is a completely different question.) Continue to use whatever is easiest for your team. I still almost always use saline myself.”
Morgenstern, J. The BaSICS trial: Normal saline has been fine all along, First10EM, August 11, 2021. Available at:https://doi.org/10.51684/FIRS.83995
Recent evidence
What is the evidence for this practice? Recent studies put the value of fluids in to question in the peri-intubation period. We bottom line it for you below and give you access to the deeper dive on RebelEM.
Clinical Take Home Point: “Putting all the evidence together (PrePARE and PrePARE II), the administration of 500mLs of fluid prior to intubation does not seem to decrease the incidence of cardiovascular collapse in critically ill adult patients undergoing tracheal intubation and should not be routine practice. “Resuscitate before you intubate” is a nuanced procedure that requires focused interventions based on the patient’s pathophysiology”. – RebelEM. Another great way to build your learning network đź’Ş
- Russell DW et al. Effect of Fluid Bolus Administration on Cardiovascular Collapse Among Critically Ill Patients Undergoing Tracheal Intubation: A Randomized Clinical Trial. JAMA 2022. PMID: 35707974 [Access on Read by QxMD]
- Janz DR et al. PrePARE Investigators; Pragmatic Critical Care Research Group. Effect of Fluid Bolus on Cardiovascular Collapse Among Critically Ill Adults Undergoing Tracheal Intubation (PrePARE): A Randomised Controlled Trial. Lancet Respir Med 2019 PMID: 31585796
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