Fluid responsiveness-guided preinduction volume optimization and postinduction hypotension in older adults at increased frailty risk: A randomized clinical trial
In brief
Fluid-guided preparation cut early postinduction hypotension from 72% to 38%
In a randomized trial of 100 older adults at increased frailty risk, fluid responsiveness-guided volume optimization reduced the share with at least one blood pressure reading below 65 mmHg in the first 15 minutes after induction from 72% to 38%. The average difference in lowest blood pressure was modest, and whether preventing these episodes improves clinical outcomes remains unknown.
- Journal
- Journal of clinical anesthesia (Q1)
- Published
- 9 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Miao Wang, Cheng Xu, Chunyang Zhang, Kehan Wang, Jie Lu, Quanhong Zhou
- PMID
- 42854351
- DOI
- 10.1016/j.jclinane.2026.112332
Why clinicians should know about it
- Picked for Anesthesiology and Pain Medicine (top studies of the week, 18 October 2026): Fluid‑responsive volume optimisation reduces hypotension
Abstract
STUDY OBJECTIVE: To determine whether preinduction volume optimization guided by fluid responsiveness reduces postinduction hypotension in older adults at increased frailty risk. DESIGN: Single-center randomized controlled trial. SETTING: Shanghai Sixth People's Hospital, Shanghai, China. PATIENTS: One hundred adults aged 65 years or older with Risk Analysis Index-C scores greater than 15 undergoing elective gastrointestinal surgery. INTERVENTIONS: Participants were assigned 1:1 to preinduction volume optimization guided by passive leg raising and echocardiographic left ventricular outflow tract velocity-time integral, or usual care. Fluid-responsive participants received 8 mL/kg succinylated gelatin boluses until optimization. MEASUREMENTS: The primary outcome was the occurrence of any mean arterial pressure (MAP) below 65 mmHg during postinduction minutes 1 through 15. MAIN RESULTS: Forty-six of 50 optimization participants were fluid responsive and received colloid. At least 1 MAP value below 65 mmHg occurred in 19 of 50 participants (38%) with optimization and 36 of 50 (72%) with usual care (risk difference, -34.0 percentage points [95% CI, -50.1 to -14.5]; relative risk, 0.53 [95% CI, 0.36 to 0.78]; P = .001). The number needed to treat was 3 (95% CI, 2 to 7), and the fragility index was 7. The mean minimum MAP differed by 4.3 mmHg; the median number of scheduled observations below 65 mmHg was 0 vs 2. CONCLUSIONS: In selected older adults at increased frailty risk, preinduction volume optimization reduced early postinduction hypotension. Differences in hypotension depth and burden were modest, and clinical benefit remains uncertain. CLINICAL TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2500095294; registered 6 January 2025; https://www.chictr.org.cn/showproj.html?proj=255888).
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.