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WORLD EMERGENCY MEDICINE SOCIETIES & RELATED

Rebellion in EM 2019: 3 Things That Have Changed the Way I Intubate

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sábado, 26 de octubre de 2019

Fluid boluses before intubation

PulmCrit (EMCrit)
PulmCrit - October 21, 2019 - By Josh Farkas

"Summary The Bullet:
  • Fluid boluses are ineffective for supporting blood pressure in the peri-intubation period during intubation of ICU patients. There are numerous reasons for this, including lack of fluid responsiveness and the long duration required to give a fluid bolus.
  • Lack of a clinically significant effect of fluid boluses on blood pressure has been demonstrated previously in a systematic review of prospective trials in septic shock. This is now confirmed in the PREPARE trial, a prospective multi-center pragmatic study.
  • There are numerous reasons that vasopressors are potentially superior to fluid for hemodynamic stabilization of the peri-intubation patient: greater efficacy, faster onset, greater titratability, and avoidance of fluid overload.
  • If a patient is believed to be volume depleted and this hypovolemia is felt to be detrimental, then fluid resuscitation is indicated. The decision to provide fluid should ideally be driven by the patient’s hypovolemic status, rather than a fleeting desire to improve hemodynamics during intubation.
  • If you’re bringing a liter bag of fluid into a high-risk intubation with hopes of staving off hemodynamic decompensation, you’re bringing a knife to a gunfight."