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Efecto de la administración de líquido en bolo sobre el colapso cardiovascular en pacientes en estado crítico
Derek W Russell1,2, Jonathan D Casey3, Kevin W Gibbs4
1Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama Heersink School of Medicine, Birmingham.
JAMA
|June 16, 2022
Resumen
La administración de bolus intravenosos de líquido a adultos en estado crítico durante la intubación traqueal no redujo significativamente el colapso cardiovascular. Este hallazgo sugiere que los bolos de líquido no son efectivos para prevenir la hipotensión, el paro cardíaco o la muerte en esta población de pacientes.
Área de la Ciencia:
- Medicina de cuidados intensivos
- Anestesiología
- Fisiología cardiovascular
Sus antecedentes:
- La hipotensión es una complicación frecuente durante la intubación traqueal en adultos en estado crítico.
- Esta complicación aumenta el riesgo de resultados adversos, incluido el paro cardíaco y la muerte.
Objetivo del estudio:
- Investigar la eficacia de la administración intravenosa de líquidos en bolo para prevenir la hipotensión severa, el paro cardíaco y la muerte durante la intubación traqueal en adultos en estado crítico.
Principales métodos:
- Un ensayo clínico aleatorizado en el que participaron 1067 adultos en estado crítico sometidos a intubación traqueal.
- Los participantes fueron asignados al azar para recibir un bolo intravenoso de 500 ml de líquido o ningún bolo de líquido.
- El resultado primario fue el colapso cardiovascular, definido por el uso de vasopresores, presión arterial sistólica baja, paro cardíaco o muerte dentro de una hora después de la incubación.
Principales resultados:
- No hubo diferencias significativas en la incidencia de colapso cardiovascular entre el grupo de bolus fluido (21,0%) y el grupo sin bolus fluido (18,2%).
- Las tasas de uso de vasopresores nuevos o aumentados, hipotensión severa, paro cardíaco y muerte fueron similares entre los grupos.
- No hubo diferencias significativas en la mortalidad a los 28 días (censurada en el alta hospitalaria) entre los grupos de bolus de líquido (40,5%) y de no bolus de líquido (42,3%).
Conclusiones:
- La administración intravenosa de líquido en bolo no disminuyó significativamente la incidencia de colapso cardiovascular en adultos en estado crítico sometidos a intubación traqueal.
- Los hallazgos sugieren que la administración rutinaria de líquidos en bolo puede no ser beneficiosa para prevenir eventos hemodinámicos adversos durante este procedimiento.
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