The Prescribing Patterns of Diuretics in Intensive Care Retrospective Study About 64 Cases

Abstract

Diuretics are commonly recommended in medical practice, utilized for both chronic management and emergency interventions in intensive care units., due to their powerful pharmacological effect. However, their use in the intensive care setting is sometimes inappropriate and excessive, leading to errors in indication and significantly increased iatrogenic harm. Our study aims to evaluate the use of diuretics in intensive care units by examining the indications for prescription as well as their clinical and biological impacts, in order to elucidate practical guidelines for optimal use ensuring relevant and safe employment while eliminating harmful practices that could have serious consequences for the health of intensive care patients. To achieve this, we conducted a retrospective descriptive case series study involving patients hospitalized in the medical intensive care unit of CHU Ibn Rochd in Casablanca from January 1, 2022, to December 31, 2022. Demographic, clinical, paraclinical, therapeutic, and evolutionary data were collected. Out of the 292 patients hospitalized in the medical intensive care unit during the year 2022, 64 cases of diuretic use were collected, with an incidence of 21.91%. The most frequent indications for diuretic use in our series were acute renal failure and inadequate diuresis, followed by acute respiratory distress syndrome and heart failure. Furosemide was the only diuretic prescribed in our series. Following diuretic administration, hemodynamic, metabolic, and organic complications were observed. The most frequently encountered complications were arterial hypotension requiring the use of vasoactive drugs in some cases, hypokalemia, and impaired renal function. Mortality was high in our series, with death occurring in 77% of our patients. The indications for diuretics in intensive care have changed over the last decade. They are no longer recommended in cases of acute renal failure to maintain diuresis or to preserve renal function, nor in hepatorenal syndrome as this can worsen renal perfusion and acute renal injury. However, as part of fluid balance regulation by the intensivist, diuretic administration may be considered in organ congestion, particularly pulmonary, and in various situations such as ventilatory weaning, acute heart failure, and acute respiratory distress syndrome, provided that this use is carefully evaluated and associated with precise administration modalities, in addition to appropriate compensatory treatments to prevent their adverse effects.