Continuous Infusion versus Intermittent Bolus Injections of Furosemide in Congestive Heart Failure

Abstract

Abstract Background Loop diuretic therapy (Furosemide) plays a pivotal role in the treatment of CHF. Despite the lack of mutual agreement about the best approach to use Furosemide in CHF, its demonstrated efficacy and the long clinical experience with it suggest that it will remain an integral part in management of the CHF. Ongoing investigation into the optimal strategy to administer furosemide is a must to maintain its efficacy and minimize its adverse effects. Aim of the Work To compare continuous infusion and bolus intermittent injection of Furosemide in patients admitted with congestive heart failure. Patients and Methods In our study we tried to distinguish the most useful method of Furosemide administration whether continuous infusion or intermittent bolus injections. 40 patients (31 males and 9 females) admitted with a diagnosis of CHF were randomized in 1:1 ratio into either continuous infusion or intermittent boluses of Furosemide. On patient admission, detailed history was taken including symptoms, risk factors and etiology. Clinical examination was performed to detect rales, other signs of pulmonary edema and peripheral edema. Body weight measurement was taken as a baseline. All patients were submitted to CXR, echocardiography and laboratory assessment of renal function and electrolytes. Results Patients were then compared daily regarding BWL, UOP and clinical improvement of pulmonary rales. They were monitored for electrolytes disturbance, renal function deterioration and hemodynamic instability for first 72 hours after admission. The length of ICU stay and mortality were observed as well. Our study revealed that Furosemide administered in continuous infusion group, in comparison with intermittent bolus group, was associated with more cumulative UOP (P value 0.002) and more total BWL in 3 days (P value 0.000). This was on the expense of more incidence of hypokalemia (P value 0.002), there was no significant difference between 2 routes regarding hemodynamic parameters, renal function, mortality or length of ICU stay. Conclusion Continuous infusion of Furosemide in patients with CHF appears to provide more efficient diuresis, together with more reduction of body weight when compared to intermittent bolus therapy. However, these obtained beneficial hemodynamic effects were not reflected on the clinical course and patient outcome. Moreover, they were associated with electrolyte disturbance.