Efficacy and Safety of a Furosemide Continuous Infusion Following Cardiac Surgery

Gulbis, Brian; Spencer, Anne P.

doi:10.1345/aph.1g693

Cited by 20 publications

(12 citation statements)

References 32 publications

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“…Appropriate maintenance of the patient’s volume status is an important part of the perioperative management of patients undergoing cardiac surgery [79,80,81]. Patients often become volume overload after surgery, due in part to the large amounts of fluids received intra-operatively for cardiopulmonary bypass and hypotensive episodes [80].…”

Section: Resultsmentioning

confidence: 99%

“…If the hypervolemia is not corrected, it can contribute to the development of postoperative hypoxia, tissue edema, and delayed postoperative recovery [80,81]. One of the mainstays for postoperative fluid overload is the administration of furosemide [79]. …”

Section: Resultsmentioning

confidence: 99%

“…Appropriate maintenance of patient’s volume status is an important part of the perioperative management of patients undergoing cardiac surgery [79,80,81]. Trials assessing efficacy and safety of continuous versus intermittent intravenous infusion of furosemide in pediatric patients after cardiopulmonary bypass surgery revealed that the total furosemide dose administered by continuous intravenous infusion was generally less than the dose by intermittent intravenous administration [82,84,88,92].…”

Section: Discussionmentioning

confidence: 99%

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Clinical Pharmacology of Furosemide in Neonates: A Review

Pacifici

2013

Pharmaceuticals

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Furosemide is the diuretic most used in newborn infants. It blocks the Na+-K+-2Cl− symporter in the thick ascending limb of the loop of Henle increasing urinary excretion of Na+ and Cl−. This article aimed to review the published data on the clinical pharmacology of furosemide in neonates to provide a critical, comprehensive, authoritative and, updated survey on the metabolism, pharmacokinetics, pharmacodynamics and side-effects of furosemide in neonates. The bibliographic search was performed using PubMed and EMBASE databases as search engines; January 2013 was the cutoff point. Furosemide half-life (t1/2) is 6 to 20-fold longer, clearance (Cl) is 1.2 to 14-fold smaller and volume of distribution (Vd) is 1.3 to 6-fold larger than the adult values. t1/2 shortens and Cl increases as the neonatal maturation proceeds. Continuous intravenous infusion of furosemide yields more controlled diuresis than the intermittent intravenous infusion. Furosemide may be administered by inhalation to infants with chronic lung disease to improve pulmonary mechanics. Furosemide stimulates prostaglandin E2 synthesis, a potent dilator of the patent ductus arteriosus, and the administration of furosemide to any preterm infants should be carefully weighed against the risk of precipitation of a symptomatic patent ductus arteriosus. Infants with low birthweight treated with chronic furosemide are at risk for the development of intra-renal calcifications.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Clinical Pharmacology of Furosemide in Neonates: A Review

Pacifici

2013

Pharmaceuticals

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“…9 A continuous infusion has been found safer in the surgical setting. 10 In a randomized trial furosemide bolus versus continuous IV infusion, the IV infusion was found superior. 11 The utility of continuous infusion has been confirmed in studies with an elderly population 12 even with severe heart failure.…”

Section: Diuretic Therapymentioning

confidence: 98%

The Management of Acute Heart Failure and Diuretic Therapy

Somberg

Molnár²

2009

American Journal of Therapeutics

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One million patients are hospitalized each year with acute decompensated heart failure, and up to 20% of these patients are rehospitalized within a month after the acute presentation. Acute heart failure (AHF) accounts for 50,000 deaths annually and is the most frequent reason for hospital admissions in the United States. This article reviews the therapeutic options and the results of recent clinical trials in the treatment of AHF. Most patients can be effectively managed by use of diuretic agents or diuretics in combinations with nitrates, IV nitroglycerin, IV nitroprusside, and possibly IV nesiritide. Ultrafiltration is a promising technique that can be very helpful in the resistant patient. However, given the ease of initiation of diuretic therapy, it is unlikely that ultrafiltration would supplant diuretic use in acutely symptomatic patients. Patients in acute distress with AHF almost invariably respond to diuretics or a vasodilator combined with diuretic therapy. The loop diuretics are the most effective diuretics and thus most frequently used agents in treating AHF. Currently, there are 4 loop diuretics in the US market: furosemide, bumetanide, torsemide, and ethacrynic acid. IV furosemide and ethacrynic acid have a prompt venous dilatory effect, consequently decrease left ventricular filling pressure and immediately relieve symptoms of pulmonary congestion, before a diuresis can occur. Furosemide is more often used than ethacrynic acid due to its reduced ototoxic potential. However, ethacrynic acid should be used in sulfa-sensitive patients because ethacrynic acid is the only loop diuretic, which does not contain a sulfa moiety.

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“…To combat this, several strategies have been developed, such as repeated administration (often better than a large single dose) or addition of a thiazide-type diuretic to inhibit distal sodium resorption (92)(93)(94)(95)(96)(97)(98). Furosemide infusion is superior to, and at least as safe as, repeated large-dose boluses (95,(99)(100)(101)(102)(103). A disadvantage of intravenous infusions is that many hospitals mandate that such infusions be given in intermediate or even intensive care settings.…”

Section: Practical Tipsmentioning

confidence: 99%