Importance Hypotension is common during tracheal intubation of critically ill adults and increases the risk of cardiac arrest and death. Whether administering an intravenous fluid bolus to critically ill adults undergoing tracheal intubation prevents severe hypotension, cardiac arrest, or death remains uncertain. Objective To determine the effect of fluid bolus administration on the incidence of severe hypotension, cardiac arrest, and death. Design, Setting, and Participants This randomized clinical trial enrolled 1067 critically ill adults undergoing tracheal intubation with sedation and positive pressure ventilation at 11 intensive care units in the US between February 1, 2019, and May 24, 2021. The date of final follow-up was June 21, 2021. Interventions Patients were randomly assigned to receive either a 500-mL intravenous fluid bolus (n = 538) or no fluid bolus (n = 527). Main Outcomes and Measures The primary outcome was cardiovascular collapse (defined as new or increased receipt of vasopressors or a systolic blood pressure <65 mm Hg between induction of anesthesia and 2 minutes after tracheal intubation, or cardiac arrest or death between induction of anesthesia and 1 hour after tracheal intubation). The secondary outcome was the incidence of death prior to day 28, which was censored at hospital discharge. Results Among 1067 patients randomized, 1065 (99.8%) completed the trial and were included in the primary analysis (median age, 62 years [IQR, 51-70 years]; 42.1% were women). Cardiovascular collapse occurred in 113 patients (21.0%) in the fluid bolus group and in 96 patients (18.2%) in the no fluid bolus group (absolute difference, 2.8% [95% CI, -2.2% to 7.7%]; P = .25). New or increased receipt of vasopressors occurred in 20.6% of patients in the fluid bolus group compared with 17.6% of patients in the no fluid bolus group, a systolic blood pressure of less than 65 mm Hg occurred in 3.9% vs 4.2%, respectively, cardiac arrest occurred in 1.7% vs 1.5%, and death occurred in 0.7% vs 0.6%. Death prior to day 28 (censored at hospital discharge) occurred in 218 patients (40.5%) in the fluid bolus group compared with 223 patients (42.3%) in the no fluid bolus group (absolute difference, -1.8% [95% CI, -7.9% to 4.3%]; P = .55). Conclusions and Relevance Among critically ill adults undergoing tracheal intubation, administration of an intravenous fluid bolus compared with no fluid bolus did not significantly decrease the incidence of cardiovascular collapse. Trial Registration ClinicalTrials.gov Identifier: NCT03787732.

中文翻译：

---

液体推注对接受气管插管的危重患者心血管衰竭的影响：一项随机临床试验。

重要性 低血压在危重成人气管插管期间很常见，会增加心脏骤停和死亡的风险。对接受气管插管的危重成人进行静脉推注是否可以预防严重低血压、心脏骤停或死亡仍不确定。目的 确定推注液体对严重低血压、心脏骤停和死亡发生率的影响。设计、设置和参与者 这项随机临床试验招募了 1067 名危重成人，于 2019 年 2 月 1 日至 2021 年 5 月 24 日期间在美国 11 个重症监护病房接受气管插管、镇静和正压通气。截止日期为 2021 年 6 月 21 日。 干预措施 患者被随机分配接受 500 mL 静脉推注液体 (n = 538) 或不接受液体推注 (n = 527)。主要结局和措施 主要结局是心血管虚脱（定义为新的或增加接受血管加压药或在麻醉诱导和气管插管后 2 分钟之间收缩压 <65 mm Hg，或在麻醉诱导和 1 分钟之间心脏骤停或死亡）气管插管后一小时）。次要结局是第 28 天之前的死亡发生率，在出院时进行审查。结果 在随机分配的 1067 名患者中，1065 名 (99.8%) 完成了试验并纳入主要分析（中位年龄为 62 岁 [IQR，51-70 岁]；42.1% 为女性）。液体推注组有 113 名患者 (21.0%) 发生心血管衰竭，无液体推注组有 96 名患者 (18.2%) 发生心血管衰竭（绝对差异，2.8% [95% CI，-2.2% 至 7.7%]；P = .25）。液体推注组中 20.6% 的患者出现新的或增加的血管升压药治疗，而无液体推注组中这一比例为 17.6%，收缩压低于 65 mm Hg 的比例分别为 3.9% 和 4.2%。心脏骤停发生率分别为 1.7% 和 1.5%，死亡发生率分别为 0.7% 和 0.6%。液体推注组中有 218 名患者 (40.5%) 在第 28 天之前死亡（出院时审查），而无液体推注组有 223 名患者 (42.3%) 死亡（绝对差异，-1.8% [95% CI， -7.9% 至 4.3%]；P = .55）。结论和相关性 在接受气管插管的危重成人中，与不推注液体相比，静脉推注液体并没有显着降低心血管虚脱的发生率。试验注册 ClinicalTrials.gov 标识符：NCT03787732。