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The following is a summary of “Fluid infusion prior to intubation or anesthesia: A meta-analysis of randomized controlled trials,” published in the December 2024 issue of Critical Care by Lu et al.
The findings from previous randomized controlled trials (RCTs) varied concerning the effectiveness of rehydration before anesthesia induction.
Researchers conducted a retrospective study to analyze the effectiveness of pre-induction rehydration in individuals undergoing tracheal intubation or surgical procedures.
They followed PRISMA guidelines, which were registered in the INPLASY database (registration number: INPLASY2022100099), 2 reviewers independently searched PubMed, Embase, The Cochrane Database of Systematic Reviews, and Clinical Trials databases up until October 2022, without date restrictions. The RCTs assessing intravenous fluid administration for patients undergoing tracheal intubation or pre-surgical anesthesia induction were included. Exclusion criteria were applied to remove certain studies. Data were analyzed using RevMan (5.4.1) software after independent extraction. The primary aim was to determine whether intravenous rehydration reduced hypotensive events and the use of vasoactive drugs after anesthesia induction.
The results showed that 7 studies with a total of 2,850 patients were included, with 1,430 receiving rehydration and 1,420 in the control group. Early rehydration resulted in a lower incidence of hypotensive events compared to no rehydration [RR] 0.78; 95% [CI] 0.66 to 0.92; P = 0.004). No heterogeneity was observed (P = 0.31; I2= 16%). Subgroup analysis revealed no reduction in hypotensive events in patients with critical illness receiving rehydration before tracheal intubation (RR 0.99; 95% CI 0.61 to 1.60; P = 0.96). No significant differences in vasoactive drug use were found between the groups (RR 0.96; 95% CI 0.80 to 1.16; P = 0.69), with no heterogeneity (P = 0.26; I2 = 23%). The funnel plot showed no evidence of publication bias.
Investigators concluded the pre-induction rehydration was effective in reducing hypotensive events, specifically in the pre-surgical population, but did not demonstrate a significant decrease in the utilization of vasoactive medications.
Source: sciencedirect.com/science/article/abs/pii/S088394412400368X
