Continuous infusion of furosemide versus intermittent boluses in acute decompensated heart failure: Effect on thoracic fluid content

Abstract

IntroductionThe administration of loop diuretics in the management of acute decompensated heart failure (ADHF) whether IV boluses or continuous infusion is still controversial. We intended to evaluate differences between the two administration routes on the thoracic fluid content (TFC) and the renal functions.MethodsSixty patients with ADHF admitted to the critical care medicine department (Cairo University, Egypt) were initially enrolled in the study. Twenty patients were excluded due to EF > 40%, myocardial infarction within 30 days, and baseline serum creatinine level > 4.0 mg/dL. Furosemide (120 mg/day) was given to the remaining 40 pts who continued the study after 1:1 randomization to either continuous infusion (group-I, 20 pts) or three equal intermittent daily doses (group-II, 20 pts). Subsequent dose titration was allowed after 24 h, but not earlier, according to patient’s response. No other diuretic medications were allowed. All patients were daily evaluated for NYHA class, urine output, TFC, body weight, serum K+, and renal chemistry.ResultsThe median age (Q1–Q3) was 54.5 (43.8–63.8) years old with 24 (60%) males. Apart from TFC which was significantly higher in group-I, the admission demographic, clinical, laboratory and co-morbid conditions were similar in both groups. There was statistically insignificant tendency for increased urine output during the 1st and 2nd days in group-I compared to group-II (p = .08). The body weight was decreased during the 1st day by 2 (1.5–2.5) kg in group-I compared to 1.5 (1–2) kg in group-II, (p = .03). These changes became insignificant during the 2nd day (p = .4). The decrease of TFC was significantly higher in group-I than in group-II [10 (6.3–14.5) vs 7 (3.3–9.8) kΩ−1 during the first day and 8 (6–11) vs 6 (3.3–8.5) kΩ−1 during the second day in groups-I&II respectively, P = .02 for both]. There was similar NYHA class improvement in both groups (p = .7). The serum creatinine was increased by 0.2 (0.1–0.5) vs 0 (−0.1 to 0.2) mg% and the CrCl was decreased by 7.4 (4.5–12.3) vs 3.1 (0.2–8.8) ml/min in groups-I&II respectively (p = .009 and .02 respectively).ConclusionsWe concluded that continuous furosemide infusion in ADHF might cause greater weight loss and more decrease in TFC with no symptomatic improvement and possibly with more nephrotoxic effect.

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

“…All-cause mortality was reported in 531 AHF patients from 5 studies [ 9 , 11 , 12 , 15 , 17 ] without obvious interstudy heterogeneity ( I 2 = 0%, P = 0.59, Figure 7 ). No significant differences in terms of all-cause mortality were observed between continuous administration and intermittent administration (RR = 1.59, 95% CI (0.92~2.75), P = 0.10) ( Figure 7 ).…”

“…The included 10 studies compared the continuous intravenous injection of furosemide with furosemide intermittent injection in hospitalized AHF patients [8][9][10][11][12][13][14][15][16][17]. Studies were performed in Asia, Europe, North America, and Africa, with 3 from the United States [10][11][12], 2 from Italy [8,9], and 1 from China [13], Turkey [14], India [15], Israel [16], and Egypt [17], respectively. The largest sample, with a total of 308 cases, was reported from the United States [11] (Table 1).…”

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

“…There are still controversies regarding differences in the efficacy and safety of continuous infusion vs bolus injection of intravenous loop diuretics in patients with acute decompensated heart failure. Most clinical trials favoured the mode of continuous infusion in terms of diuretic effect 4,6,14–16 . A variety of mechanisms may be involved in this process.…”

“…Most clinical trials favoured the mode of continuous infusion in terms of diuretic effect. 4,6,[14][15][16] A variety of mechanisms may be involved in this process. First, the approach of continuous infusion may attenuate the possibility of acute postdiuretic compensatory sodium reabsorption.…”