Continuous Infusion Of Furosemide Research Articles

Diuretic Strategies in Acute Decompensated Heart Failure: A Narrative Review.

Heart failure is a common condition with considerable associated costs, morbidity, and mortality. Patients often present to hospital with dyspnea and edema. Inadequate inpatient decongestion is an important contributor to high readmission rates. There is little evidence concerning diuresis to guide clinicians in caring for patients with acute decompensated heart failure. Contemporary diuretic strategies have been defined by expert opinion and older landmark clinical trials. To present a narrative review of contemporary recommendations, along with their underlying evidence and pharmacologic rationale, for diuretic strategies in inpatients with acute decompensated heart failure. PubMed, OVID, and Embase databases were searched from inception to December 22, 2022, with the following search terms: heart failure, acute heart failure, decompensated heart failure, furosemide, bumetanide, ethacrynic acid, hydrochlorothiazide, indapamide, metolazone, chlorthalidone, spironolactone, eplerenone, and acetazolamide. Randomized controlled trials and systematic reviews involving at least 100 adult patients (> 18 years) were included. Trials involving torsemide, chlorothiazide, and tolvaptan were excluded. Early, aggressive administration of a loop diuretic has been associated with expedited symptom resolution, shorter length of stay, and possibly reduced mortality. Guidelines make recommendations about dose and frequency but do not recommend any particular loop diuretic over another; however, furosemide is most commonly used. Guidelines recommend that the initial furosemide dose (on admission) be 2-2.5 times the patient's home dose. A satisfactory diuretic response can be defined as spot urine sodium content greater than 50-70 mmol/L at 2 hours; urine output greater than 100-150 mL/h in the first 6 hours or 3-5 L in 24 hours; or a change in weight of 0.5-1.5 kg in 24 hours. If congestion persists after the maximization of loop diuretic therapy over the first 24-48 hours, an adjunctive diuretic such as thiazide or acetazolamide should be added. If decongestion targets are not met, continuous infusion of furosemide may be considered. Heart failure with congestion can be managed with careful administration of high-dose loop diuretics, supported by thiazides and acetazolamide when necessary. Clinical trials are underway to further evaluate this strategy.

Continuous Versus Intermittent Furosemide Dosing Regimen in the Treatment of Acute Decompensated Heart Failure

Objective: To compare continuous versus intermittent (bolus) infusion of furosemide in patients with acute decompensate heart failure (ADHF) in terms of length of hospital stay, urine output per day and change in serum creatinine levels. Duration: Six months (01-09-2021 to 28-02- 2022) Setting: Cardiology department District Head Quarter Teaching Hospital (DHQ-TH) Bannu. Subjects and Methods: Eighty two (n=82) adult patients of either gender, between age 50years to 70 years were enrolled and equally divided into Group A (continuous Furosemide infusion) and group B (intermittent Furosemide dosing). Outcome of the therapy were duration of hospital stay, changes in serum creatinine and daily urine output. Results: Mean length of hospital stay was significantly shorter (5.8±2.4 days versus 6.9±2.3, p=0.04), urine output per 24 hours was higher (2796.3 ml ± 365.9 SD and 2720.7 ml ± 647.6 SD, p=0.517) and mean change (rise) in serum creatinine was significantly higher (0.41 mg/dL ± 0.26 SD and 0.27 mg/dL ± 0.32 SD respectively, p=0.027) in continuous infusion group when compared with intermittent dosing group. Conclusions: Treatment with continuous infusion of furosemide resulted in higher urine output per 24 hours, a higher rise in mean serum creatinine and a shorter duration of hospital stay as compared to treatment with intermittent dosing regimen.

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

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.

Transesophageal Echocardiography Use for Orthotopic Liver Transplant

Impact Statement: Transesophageal echocardiography (TEE) is an invaluable tool used in cardiac surgery. So why is it not consistently used in other high-risk surgeries, such as orthotopic liver transplantation (OLT)? Key Words: Transesophageal echocardiography, Liver graft, Liver transplantation Introduction: This scholarly project observes a high-risk patient undergoing an OLT. Hemorrhage, acute cardiac dysfunction, fluid shifts, and other intraoperative pathologies associated with OLT present many challenges for the anesthesia provider. Therefore, timely identification, evaluation, and intervention of intraoperative pathology are necessary to maintain hemodynamic stability. Traditionally, intra-arterial and pulmonary artery catheters (PACs) were used as hemodynamic monitors. Recently, however, transesophageal echocardiography (TEE) has been used for noncardiac surgery to assess hemodynamic status. The objective of this project is to identify the benefits gained from using TEE during OLT in addition to traditional hemodynamic monitoring techniques (CVP/PAOP) and how these findings affect fluid and medication management. Case Presentation: A 50-year-old female underwent general anesthesia for OLT. The patient’s medical history included cirrhosis, ascites, portal hypertension, portal vein thrombosis, thrombocytopenia, anemia, obesity, and coronary artery disease. Surgical history included splenic embolization and coronary artery bypass graft. The patient was transported to the OR, and standard monitors were applied. Initial VS were as follows: BP 148/75, HR 89, SpO2 92%, RR 24. The patient underwent an uneventful anesthetic induction and intubation. Sevoflurane was used to maintain anesthesia. A radial arterial line and an internal jugular introducer with a PAC were placed. Epinephrine and norepinephrine infusions were used to treat intraoperative hypotension. 1.5 L of 5% albumin, 6 U of packed red blood cells (PRBCs), 5 U of fresh frozen plasma (FFP), and 1 U of platelets were administered. Along with intraarterial blood pressure monitoring, CVP and PA pressure monitoring was used to estimate volume status and treat hypotension. Profound hypotension was treated frequently with vasopressors, fluids, and blood products throughout the case. The patient remained intubated and was transported to the intensive care unit (ICU) postoperatively. Forty-eight hours postoperatively, the patient remained intubated. Due to acute kidney injury, a continuous furosemide infusion and subsequent dialysis were required. Discussion: The reviewed literature provided ample evidence that TEE for OLT can be used to make new intraoperative diagnoses, many of these being difficult to identify by other means. Common findings included intracardiac thrombus (ICT), ventricular dysfunction, and multiple embolic pathologies. Shillcutt et al found that 88% of participants in their study had some form of abnormal TEE finding during OLT. TEE findings were also found to impact fluid and medication administration. Hofer et al found that vasopressor (56%), vasodilator (63%), and fluid management (50%) were all impacted by TEE findings in OLT patients. While evidence was provided to exhibit the efficacy of TEE as an intraoperative monitor, sufficient evidence was not provided to support better patient outcomes based on TEE assessments. This is largely due to a lack of quality observations and controlled research during OLT. The most significant evidence supporting better outcomes was from a retrospective observational cohort study that compared TEE, PAC, and a combined therapy group. The authors found that the patients undergoing OLT with both TEE and PAC had the lowest hospital length of stay (LOS), 30-day mortality, and infusion of fluids. This suggests that the addition of TEE with traditional monitors may be the safest method of hemodynamic monitoring. In the presented case study, the addition of TEE monitoring may have helped diagnose the causes of hemodynamic instability more rapidly and potentially altered medication and fluid administration. While the assumption that timely diagnosis of intraoperative findings leads to better outcomes may be reasonable, higher-powered studies are necessary to verify this assumption. Until beneficial outcomes have been validated, the use of TEE cannot be recommended as a comprehensive intervention for every OLT. However, it should be used based on the anesthesia provider’s judgment along with other monitoring tools. Conflict of Interest: I have no conflict of interest to disclose.

Continuous Infusion Versus Bolus Injection of Loop Diuretics for Patients With Congestive Heart Failure: A Meta-Analysis.

Loop diuretics continue to be a crucial component of pharmacological treatment, to eliminate extra fluid and enhance symptom control in acute decompensated heart failure (ADHF). Understanding the loop diuretics' more efficient form of administration would be very beneficial in improving the management of people's ADHF, resulting in a quicker resolution of symptoms and a notable decrease inmorbidity. To assess the outcomes of intravenous continuous infusion with bolus injection of loop diuretics for patients with ADHF, this meta-analysis was carried out. The current meta-analysis was conducted as per the Cochrane Collaboration guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension (PRISMA) guidelines. A search was carried out on PubMed and EMBASE databases for studies comparing continuous infusion with intermittent bolus injection of furosemide in patients with congestive heart failure without restriction on the language of publication from 1January 2001 to 31July 2022. The primary outcome of the meta-analysis was all-cause mortality and loss of body weight (kg). Pre-defined secondary outcomes included length of hospital stay (LOS) in days, brain natriuretic peptide(BNP) reduction (pg/ml), number of patients with hypokalemia, and urine output at 24 hours (ml). A total of nine articles were included in this meta-analysis enrolling 713 patients. No significant difference was reported between patients who received intermittent bolus injections and continuous infusion of furosemide in regards to all-cause mortality, LOS, total urine output, the incidence of hypokalemia, and change in BNP. However, the reduction of body weight was greater in the continuous infusion group compared to bolus administration. In conclusion, in the current meta-analysis of nine randomized controlled trials (RCTs), continuous infusion of furosemide seemed to have a greater reduction of body weight. However, no significant difference was there in 24-hrs urine output. However, we cannot conclude that intravenous continuous infusion has a better diuretic effect compared to bolus administration.

Advanced heart failure: parenteral diuretics for breathlessness and peripheral oedema – systematic review

BackgroundAdvanced heart failure patients suffer with breathlessness and peripheral oedema, which are frequently treated with parenteral diuretics despite limited evidence.AimTo analyse the effectiveness of parenteral diuretics on breathlessness and peripheral...

Comparison of Different Furosemide Regimens in the Treatment of Acute Heart Failure: A Meta-Analysis.

Background To compare the effects of different dosing schemes of furosemide on acute heart failure (AHF). Methods Literature that compared the efficacy of continuous and intermittent administration of furosemide in AHF patients was retrieved from PubMed, Embase, the Cochrane Library, and ISI Web of Science from inception to May 2022. The primary endpoints included overall weight loss, 24-hour urine volume, length of hospital stay, 24-hour brain natriuretic peptide (BNP) level change, and all-cause mortality. The RevmMan5.4 software was used to analyze the extracted data. Results A total of 10 studies with 775 patients, including 338 receiving continuous furosemide administration and 387 receiving intermittent furosemide administration, were included. The analysis results showed significant differences in weight loss (MD = 1.08, 95% CI (0.75~1.40), P < 0.00001) and 24-hour urine volume (MD =335.23, 95% CI (140.98~529.47), P = 0.0007) between the 2 groups. There was no significant difference in terms of length of hospital stay (MD = −0.71, 95% CI (-2.74~1.31), P = 0.49) and all-cause mortality (RR = 1.59, 95% CI (0.92~2.75), P = 0.10). Conclusions Compared with intermittent administration, continuous infusion of furosemide had a significant effect on the 24-hour urine volume and total weight loss in patients with AHF.

The Effect in Renal Function and Vascular Decongestion in Type 1 Cardiorenal Syndrome Treated with Two Strategies of Diuretics, a Pilot Randomized Trial

AimThe main treatment strategy in type 1 cardiorenal syndrome (CRS1) is vascular decongestion. It is probable that sequential blockage of the renal tubule with combined diuretics (CD) will obtain similar benefits compared with stepped-dose furosemide (SF).MethodsIn a pilot double-blind randomized controlled trial of CRS1 patients were allocated in a 1:1 fashion to SF or CD. The SF group received a continuous infusion of furosemide 100 mg during the first day, with daily incremental doses to 200 mg, 300 mg and 400 mg. The CD group received a combination of diuretics, including 4 consecutive days of oral chlorthalidone 50 mg, spironolactone 50 mg and infusion of furosemide 100 mg. The objectives were to assess renal function recovery and variables associated with vascular decongestion.ResultsFrom July 2017 to February 2020, 80 patients were randomized, 40 to the SF and 40 to the CD group. Groups were similar at baseline and had several very high-risk features. Their mean age was 59 ± 14.5 years, there were 37 men (46.2%). The primary endpoint occurred in 20% of the SF group and 15.2% of the DC group (p = 0.49). All secondary and exploratory endpoints were similar between groups. Adverse events occurred frequently (85%) with no differences between groups (p = 0.53).ConclusionIn patients with CRS1 and a high risk of resistance to diuretics, the use of CD compared to SF offers the same results in renal recovery, diuresis, vascular decongestion and adverse events, and it can be considered an alternative treatment. ClinicalTrials.gov with number NCT04393493 on 19/05/2020 retrospectively registered.

Comparison of continuous infusion and intermittent boluses of furosemide in acute heart failure: A protocol for systematic review and meta-analysis.

Background:Acute heart failure (HF) is a common cause of hospital admission. This study aims to compare continuous infusion and intermittent boluses of furosemide in treating acute HF.Methods:This protocol of systematic review and meta-analysis has been drafted under the guidance of the preferred reporting items for systematic reviews and meta-analyses protocols. Electronic databases including Web of Science, Embase, PubMed, Wanfang, Data, Scopus, Science Direct, and Cochrane Library will be searched in June 2021 by 2 independent reviewers. The main outcomes are post-treatment daily urine output, weight, length of stay, serum sodium, potassium, and creatinine. Two researchers conducted a quality assessment in strict accordance with the risk bias assessment tool recommended by the Cochrane Handbook Version5.3. We performed the meta-analysis by Stata version 10.0 software.Results:The results of this systematic review and meta-analysis will be published in a peer-reviewed journal.Conclusion:The choice of furosemide regime in acute HF remains physician preference. Both bolus and continuous infusion yields satisfactory outcomes.

A Study on Continuous Infusion versus Intermittent bolus dosing of Furosemide in Hospitalized Heart failure patients

Introduction: Intravenous loop diuretics is one of the cornerstone therapy of heart failure patients presenting with congestion, however the optimal dosage and administration strategies remain poorly defined. We intended to evaluate the differences between the two administration routes based on the efficacy and the renal functions. Methods: Sixty patients with heart failure admitted in the critical care medicine were initially enrolled in the study. Four patients were excluded due to eGFR&lt;15ml/min. The remaining 28 patients in each group (Group I: continuous furosemide infusion (cIV) and Group II: intermittent furosemide bolus injections (iIV) i.e., three equal intermittent daily doses) were administered with Inj. Furosemide (120mg/day). All patients were daily evaluated for NYHA class, urine output, serum electrolytes, BNP, and renal parameters. Results: The efficacy of the either group of intravenous administration were evaluated using the following end points such as cumulative urine output (2,505±796 vs 2140±468 ml/day, p &lt; 0.04), serum creatinine levels, B.U.N levels, G.F.R and BNP levels. 56 patients were studied with 28 in each group. The c1V group showed an increase in urine output and a more significant decrease in the BNP levels when compared to the bolus. We observed a significant difference in GFR (p&lt;0.05), creatinine (p&lt;0.01) and B.U.N (p&lt;0.05) from baseline to the end of treatment in both the groups. Conclusion: The administration of intermittent furosemide bolus injection (iIV) is better than continuous furosemide infusion (c1V). Theoretically, cIV appeared to provide more efficient gradual diuresis with less neurohormonal activation, however it was also associated with increased rate of worsening renal function during hospitalisation.

Continuous versus intermittent use of furosemide in patients with heart failure and moderate chronic renal dysfunction.

AimsThere is paucity of clinical data comparing continuous infusion (CI) with bolus injection (BI) of intravenous loop diuretics in patients with acute decompensated heart failure (ADHF) and chronic renal dysfunction. This study aimed to compare the efficacy and safety of CI versus BI intravenous furosemide administration in patients with ADHF and moderate chronic renal insufficiency.Methods and resultsAcute decompensated heart failure and moderate chronic renal insufficiency [with estimated glomerular filtration rate (eGFR) 15.0–44.9 mL/min/1.73 m2] were randomized to start intravenous furosemide by BI or by a 6 h CI. End points included freedom from congestion at 72 h, the degree of dyspnoea assessed using the 0–10 Borg's category ratio scale, net daily urine output, weight loss during the study, length of hospital stay, total urinary sodium excretion, and development of acute kidney injury or electrolyte disturbance. After 72 h of treatment, the rate of the primary endpoint of freedom from congestion in the CI group was significantly higher than that in the BI group (69.05% vs. 43.59%, P = 0.02). The modified Borg scale indicated patients in the CI group had lower dyspnoea score than those in the BI group at 48 h (4.29 ± 1.23 vs. 5.97 ± 1.56; P = 0.02) and 72 h (1.15 ± 0.35 vs. 2.66 ± 0.83; P = 0.003). There were other significant differences favouring the CI group with regard to net urine output at 72 h (5145.98 ± 621.37 mL vs. 3755.95 ± 456.93 mL; P = 0.007), the mean body weight loss (4.72 ± 1.01 kg vs. 3.53 ± 0.73 kg; P = 0.02) and the total urinary sodium excretion (385.05 ± 38.15 vs. 320.33 ± 37.67; P = 0.02). The length of hospitalization in the CI group was significantly shorter than that in the BI group (10.36 ± 4.20 days vs. 15.68 ± 6.15 days; P = 0.02). No significant differences were observed between groups in the frequency of acute kidney injury, tinnitus, electrolyte disturbance or mortality.ConclusionsContinuous intravenous infusion of furosemide resulted in significantly greater diuresis than bolus administration of an equal dose in patients with moderate chronic renal insufficiency and ADHF, while no differences emerged in terms of side effects or mortality.

Adjunct Hypertonic Saline in Patients with Diffuse Edema Due to Heart Failure: A Randomized Double-Blinded Clinical Trial.

In patients with diuretic resistance due to heart failure, higher doses or continuous furosemide infusion and adding hypertonic saline solution (HSS) to diuretics could be effective. The goal of this study was to assess the effectiveness of hypertonic saline solution administration in weight loss of hospitalized patients with diuretic-resistant edema due to heart failure. In a randomized double-blinded clinical trial, adult patients with diffuse peripheral edema due to heart failure who were unresponsive to 80 mg of oral furosemide were enrolled. The patients were randomized into two groups. In the intervention and control groups, patients received 150 mL of HSS and normal saline, respectively. Subjects in both groups received 250 mg IV furosemide every 12 h for 48 h. The change in body weight, urine output, blood pressure, uric acid, urine osmolality, blood biochemistry, and urinary cystatin C levels were assessed. Based on defined inclusion and exclusion criteria, 28 patients, 14 in each group, were recruited. The groups were similar in demographic and baseline laboratory characteristics. A significant decrease in body weight was observed in the intervention group (P = 0.002). The change in other measured parameters, including urine output and urinary cystatin C levels, was not reached statistical significance. Our findings suggest that the administration of HSS as an adjunct to loop diuretics could provide a safe and effective treatment for increasing urine output and decreasing weight in patients with heart failure.

Tolvaptan vs. furosemide-based diuretic regimens in patients hospitalized for heart failure with hyponatremia (AQUA-AHF).

AimsHyponatremia is associated with poorer outcomes and diuretic response in patients hospitalized for heart failure. This study compared a tolvaptan‐based vs. furosemide‐based diuretic regimen on short‐term clinical responses in hyponatremic acute heart failure.Methods and resultsProspective, randomized, open‐label, parallel‐group, single‐centre study comparing oral tolvaptan vs. continuous infusion furosemide. Thirty‐three subjects requiring hospitalization for acute congestive heart failure, and a serum sodium < 135 mmol/L, were randomized to tolvaptan 30 mg orally daily or furosemide 5 mg/h intravenously for initial 24 h, after which treatments could be escalated. Median daily dose throughout was tolvaptan 30 mg and furosemide 120 mg, with four subjects in each group requiring dose escalation. Urine output and net fluid balance were not different between groups at 24 h or subsequent time points up to 96 h. Changes in estimated glomerular filtration rate were comparable. Cystatin C improved at 24 h with tolvaptan compared with furosemide (−6.4 ± 11.8 vs. 4.1 ± 17.2% change, P = 0.036), but the effect was transient. No significant between group differences were seen for NT‐proBNP, plasma renin activity, or urinary neutrophil gelatinase‐associated lipocalin:Cr. Serum sodium, as well as copeptin levels, increased with tolvaptan compared with furosemide.ConclusionsOral tolvaptan was associated with similar, but not superior, diuresis compared with intravenous furosemide for acute heart failure with concomitant hyponatremia.

Very High-Dose Furosemide Continuous Infusions: A Case Series

BackgroundThere is paucity of data evaluating the efficacy and safety of very high-dose furosemide continuous infusions (≥40 mg/h) for volume removal. This infusion is a novel strategy of loop diuretic administration that may add valuable data to current literature. Methods and ResultsThis was a retrospective chart review. Patients were eligible for inclusion if prescribed a very high-dose furosemide infusion (defined as ≥40 mg/h, up to 240 mg/h) from April 1, 2017, to January 1, 2019, at Thomas Jefferson University Hospital. Data collected included the change in cumulative urine output, net urine output, incidence of acute kidney injury, occurrences of hypotension, electrolyte abnormalities, body weight, and ototoxicity. Twenty-two patients were included in this analysis. The median change in 24-hour urine output from before to after very high-dose continuous furosemide infusion increased from 1193 mL at 24 hours before infusion initiation to 3518 mL at 24 hours after infusion initiation (P < .01). Serum creatinine increased 24 hours after infusion initiation but decreased within 48 hours. There were no electrolyte abnormalities. Out of 22 patients, only 2 had an occurrence of hypotension. No patients were reported to have ototoxicity. ConclusionsVery high-dose furosemide continuous infusions provide a significant increase in diuresis without worsening renal function, disturbing electrolytes, or increasing the risk of ototoxicity. Further studies are necessary to examine the efficacy and safety of this novel strategy.

Acid-base effects of continuous infusion furosemide in clinically stable surgical ICU patients: an analysis based on the Stewart model.

We sought to test the strength of correlation between predicted and observed systemic acid-base status based on the Stewart model equations during continuous infusion (CI) furosemide therapy. This was a prospective, single-center, observational study conducted in the Surgical ICU of a large academic medical center. Ten critically ill patients who received CI furosemide were included. The primary purpose was to characterize the relationship between changes in serum electrolyte and acid-base status and the excretion of electrolytes in the urine during infusion of CI furosemide in critically ill patients. As a secondary endpoint, we sought to evaluate the predictive application of the Stewart model. Over 72-h, intake and output volumes, electrolyte content of fluids administered, plasma and urine electrolytes, urine pH, and venous blood gases were collected. Predicted and observed changes in acid-based status were compared for each day of diuretic therapy using Spearman's correlation coefficient. The mean (SD) strong ion difference (SID) increased from 45.2 (3.2) at baseline to 49.6 (4.0) after 72h of continuous infusion furosemide. At Day 1, the mean SID (observed) (SD) was 47.5 (3.5) and the predicted SID was 49.5 (5.8). Day 1 observed plasma SID was positively correlated with the predicted SID (rs = 0.80, p = 0.01). By Days 2 and 3, the correlations of observed and predicted SID were no longer statistically significant. Using the Stewart model, increases in SID as an indicator of metabolic alkalosis due to the chloruretic effects of furosemide were observed. Predicted and observed SID correlated well over the first 24h of treatment.

Differences between Continuous Infusion and Intermittent Bolus of Furosemide with Length of Hospital Stay in Patients with Acute Heart Failure in Haji Adam Malik General Hospital Medan

Background: Heart failure is a complication that often occurs in individuals with or without underlying cardiovascular disease. Furosemide serves to reduce preload and improve congestion symptoms. The aim of this study was to determine the difference in length of hospital stay between continuous infusion and intermittent bolus of furosemide in patients with acute heart failure.Methods: This study was a prospective-single blind-randomized controlled study of 54 people with acute heart failure who entered the emergency room and underwent treatment at the H. Adam Malik Hospital from October 2018 to March 2019. Re-examination of urine production, kidney function, and electrolytes was carried out after 72 hours of treatment. Subsequent subjects were observed during treatment for death during treatment and duration of treatment. Follow-up was carried out for 30-days to assess rehospitalization.Results: Between continuous infusion group and intermittent bolus group, we found, respectively, length of hospital stay 7.6±3.2 vs. 7.3±4.8 days, p=0.28; urine production 2241±429 vs 2020±368, p=0.048; ∆BUN 3.6 ± 14.5 vs 4.0 ± 10.9, p=0.91; ∆Ureum 7.9 ± 31.0 vs 8.5 ± 23.3; p=0.92; ∆Creatinine 0.1 ± 0.61 vs. 0.03 ± 0.33; p=0.56; and ∆GFR -5.5 ± 20.6 vs -2.7 ± 22.7; p=0.64. In terms of mortality during hospitalization, we found that 7.4% vs 11.1%, p=0.63 (HR 0.64; 95% CI: 0.098–4.1) and rehospitalization in 30 days showed 22.2% vs 37%; p=0.23 (HR 0.48; 95% CI: 0.14–1.6) in continuous infusion vs. intermittent bolus group, respectively.Conclusions: In patients with acute heart failure, there is no difference between continuous infusion and intermittent bolus of furosemide in regard to length of hospital stay, changes in renal function and electrolyte, death during hospitalization, and rehospitalization within 30-days. However, continuous administration of furosemide infusion is better in urine production.

Diuretic Efficacy of Continuous Furosemide Infusion versus Bolus Injections in Children with Decompensated Heart Failure

Diuretic Efficacy of Continuous Furosemide Infusion versus Bolus Injections in Children with Decompensated Heart Failure

Furosemide as a functional marker of acute kidney injury in ICU patients: a new role for an old drug.

New pharmacokinetics insight suggests that the furosemide pharmacology occurring in ICU patients with AKI is similar, but not equal to that described in chronic stable renal patients. Even if the diuretic response to furosemide is expressed by a steep dose-response curve positively correlated with renal function, pharmacodynamic limitations occur when creatinine clearance is < 20ml/min or urine output is < 500ml/12h. In such cases, other factors specifically due to acute tubular injury can interfere with the furosemide-induced diuretic output. As modality of administration recent reports and metanalysis, even if not conclusive, suggest that for the same given dose a continuous infusion of furosemide was superior in diuretic response. For septic shock patients on CVVHDF where treatment adds an additional clearance of furosemide the maximum diuretic response is achieved by a continuous infusion of 20mg/h of furosemide. At this infusion rate the reached plasma level was < 20mg/L, a range considered safe and not ototoxic. Therefore, the severity of AKI establishes whether a patient will respond to furosemide. In this review we summarized all these recent updates, also suggesting that the diuretic response under continuous infusion may allow assessing glomerular and tubular functions with increased reliability than a bolus dose. However, validation studies are still needed to support continuous infusion as a stress test.

Effect of continuous furosemide infusion on outcome of acute kidney injury.

Objective:To evaluate the clinical effects of continuous intravenous infusion with high-dose furosemide on early acute kidney injury (AKI) complicated with acute lung edema.Methods:Ninety patients who had been treated by furosemide at routine dose for 12 hour but with unsatisfactory outcomes were selected and subjected to continuous intravenous infusion with high-dose furosemide. The dose was adjusted according to hourly urine output. Serum levels of urea nitrogen, creatinine and potassium, pH, oxygenation index and mechanical ventilation time before and 6, 12, 24, 48 and 72 hour after treatment were compared.Results:The urine outputs before and 6, 12, 24, 48 and 72 hour after treatment were (10.71 ± 1.81), (164.52 ± 21.42), (189.71 ± 29.61), (181.33 ± 23.52), (176.82 ± 24.80) and (164.52 ± 18.91) ml/h respectively. Compared with data before treatment, the serum levels of urea nitrogen, creatinine and potassium significantly decreased while pH and oxygenation index significantly increased after six hour of treatment (P<0.05). After treatment, the kidney functions of 80 patients (88.9%) were completely recovered, without obvious adverse reactions.Conclusion:For patients with early AKI complicated with acute pulmonary edema who cannot be cured by diuretic agent at routine dose, high-dose furosemide increases urine output and improves success rate.

Association between diuretics and successful discontinuation of continuous renal replacement therapy in critically ill patients with acute kidney injury

BackgroundDespite aggressive application of continuous renal replacement therapy (CRRT) in critically ill patients with acute kidney injury (AKI), there is no consensus on diuretic therapy when discontinuation of CRRT is attempted. The effect of diuretics on discontinuation of CRRT in critically ill patients was evaluated.MethodsThis retrospective cohort study enrolled 1176 adult patients who survived for more than 3 days after discontinuing CRRT between 2009 and 2014. Patients were categorized depending on the re-initiation of renal replacement therapy within 3 days after discontinuing CRRT or use of diuretics. Changes in urine output (UO) and renal function after discontinuing CRRT were outcomes. Predictive factors for successful discontinuation of CRRT were also analyzed.ResultsThe CRRT discontinuation group had a shorter duration of CRRT, more frequent use of diuretics after discontinuing CRRT, and greater UO on the day before CRRT discontinuation [day minus 1 (day − 1)]. The diuretics group had greater increases in UO and serum creatinine elevation after discontinuing CRRT. In the CRRT discontinuation group, continuous infusion of furosemide tended to increase UO more effectively. Multivariable regression analysis identified high day − 1 UO and use of diuretics as significant predictors of successful discontinuation of CRRT. Day − 1 UO of 125 mL/day was the cutoff value for predicting successful discontinuation of CRRT in oliguric patients treated with diuretics following CRRT.ConclusionsDay − 1 UO and aggressive diuretic therapy were associated with successful CRRT discontinuation. Diuretic therapy may be helpful when attempting CRRT discontinuation in critically ill patients with AKI, by inducing a favorable fluid balance, especially in oliguric patients.