Fluid infusion prior to intubation or anesthesia: A meta-analysis of randomized controlled trials

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE Journal of critical care Pub Date : 2024-07-24 DOI:10.1016/j.jcrc.2024.154881

Zhenfeng Lu , Jingsheng Guo , Aiping Zhang , Lin Song , Haibin Ni

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Abstract

Background

The results of current randomized controlled trials (RCTs) vary regarding the effectiveness of rehydration prior to anesthesia induction. Our objective was to determine the effectiveness of pre-induction rehydration in patients undergoing tracheal intubation or surgical procedures.

Methods

This meta-analysis followed PRISMA guidelines and was registered in the INPLASY database (registration number: INPLASY2022100099). Two reviewers independently searched PubMed, Embase, The Cochrane Database of Systematic Reviews, and Clinical Trials databases until October 2022, without any restrictions on date. Any randomized controlled trial investigating the administration of intravenous fluids to patients undergoing tracheal intubation or pre-surgical anesthesia induction was considered eligible. Exclusion criteria were applied to exclude certain literature. Data were analyzed using RevMan (5.4.1) software after independent extraction. The primary objective of this study was to determine if intravenous rehydration could reduce the occurrence of hypotensive events and the use of vasoactive drugs following anesthesia induction.

Results

This meta-analysis included seven studies with a total of 2850 patients, including 1430 patients who received rehydration and 1420 control patients. Patients who received early rehydration had a lower incidence of hypotensive events compared to those who did not (RR 0.78, 95% CI 0.66–0.92, P = 0.004). No heterogeneity was observed (p = 0.31, I² = 16%). However, subgroup analysis showed that rehydration before tracheal intubation did not reduce hypotensive events in critically ill patients (RR 0.99, 95% CI 0.61–1.60, P = 0.96). There were no significant differences in the use of vasoactive medications between the two study groups (RR 0.96, 95% CI 0.80–1.16, P = 0.69). No heterogeneity was observed (p = 0.26, I² = 23%). The funnel plot indicated no evidence of publication bias.

Conclusions

Pre-induction rehydration can reduce the occurrence of hypotensive events, but only in pre-surgical patients, and does not decrease the use of vasoactive medications.

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插管或麻醉前输液：随机对照试验荟萃分析。

背景：关于麻醉诱导前补液的效果，目前的随机对照试验（RCT）结果各不相同。我们的目的是确定气管插管或外科手术患者诱导前补液的有效性：该荟萃分析遵循 PRISMA 指南，并在 INPLASY 数据库中注册（注册号：INPLASY2022100099）。两位审稿人独立检索了 PubMed、Embase、The Cochrane Database of Systematic Reviews 和 Clinical Trials 数据库，检索时间截止到 2022 年 10 月，没有任何日期限制。符合条件的随机对照试验均涉及对接受气管插管或手术前麻醉诱导的患者进行静脉输液的研究。排除标准适用于排除某些文献。数据经独立提取后使用RevMan（5.4.1）软件进行分析。本研究的主要目的是确定静脉补液是否能减少麻醉诱导后低血压事件的发生和血管活性药物的使用：这项荟萃分析包括七项研究，共涉及 2850 名患者，其中 1430 名患者接受了补液治疗，1420 名患者接受了对照治疗。与未接受补液的患者相比，接受早期补液的患者发生低血压事件的几率较低（RR 0.78，95% CI 0.66-0.92，P = 0.004）。未观察到异质性（P = 0.31，I2 = 16%）。然而，亚组分析显示，气管插管前补液并不能减少重症患者的低血压事件（RR 0.99，95% CI 0.61-1.60，P = 0.96）。两个研究组在使用血管活性药物方面没有明显差异（RR 0.96，95% CI 0.80-1.16，P = 0.69）。未观察到异质性（P = 0.26，I2 = 23%）。漏斗图显示没有证据表明存在发表偏倚：诱导前补液可减少低血压事件的发生，但仅限于手术前患者，且不会减少血管活性药物的使用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of critical care 医学-危重病医学

CiteScore

8.60

自引率

2.70%

发文量

237

审稿时长

23 days

期刊介绍： The Journal of Critical Care, the official publication of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM), is a leading international, peer-reviewed journal providing original research, review articles, tutorials, and invited articles for physicians and allied health professionals involved in treating the critically ill. The Journal aims to improve patient care by furthering understanding of health systems research and its integration into clinical practice. The Journal will include articles which discuss: All aspects of health services research in critical care System based practice in anesthesiology, perioperative and critical care medicine The interface between anesthesiology, critical care medicine and pain Integrating intraoperative management in preparation for postoperative critical care management and recovery Optimizing patient management, i.e., exploring the interface between evidence-based principles or clinical insight into management and care of complex patients The team approach in the OR and ICU System-based research Medical ethics Technology in medicine Seminars discussing current, state of the art, and sometimes controversial topics in anesthesiology, critical care medicine, and professional education Residency Education.