Frusemide Administration in Critically Ill Patients by Continuous Compared to Bolus Therapy

Ostermann, Marlies; Alvarez, George; Sharpe, Michael D.; Martin, Claudio M.

doi:10.1159/000108641

Cited by 44 publications

(26 citation statements)

References 55 publications

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“…4,9 Studies of bolus versus continuous dosing of intravenous loop diuretics in patients hospitalized for non-HF causes have also been small and heterogenous and have shown mixed results. 10–12 …”

Section: Discussionmentioning

confidence: 99%

Continuous Versus Bolus Dosing of Furosemide for Patients Hospitalized for Heart Failure

Allen

Turer

DeWald

et al. 2010

The American Journal of Cardiology

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Intravenous diuretics are the cornerstone of management for patients hospitalized for heart failure. Physiologic data suggest that intermittent high-dose furosemide promotes neuro-hormonal activation, which a slow continuous infusion might remediate. However, the limited clinical data comparing dosing schemes are confounded. This study was a randomized, open-label, single-center trial of twice-daily bolus injection versus continuous infusion furosemide in patients hospitalized with heart failure and volume overload. The primary outcome was change in creatinine from admission to hospital day 3 or discharge. Twenty-one patients were randomized to bolus injection and 20 patients to continuous infusion. Baseline characteristics were balanced between study arms except for gender, with a mean age of 60 ± 15 years, a mean ejection fraction of 35 ± 19%, and a mean creatinine level of 1.9 ± 1.2 mg/dl. The mean doses of furosemide were similar between arms over the first 48 hours (162 ± 48 and 162 ± 52 mg/24 hours). None of the outcomes differed significantly between bolus and continuous dosing from admission to hospital day 3 or discharge (mean change in creatinine −0.02 vs 0.13 mg/dl, p = 0.18; urine output 5,113 vs 4,894 ml, p = 0.78; length of stay 8.8 vs 9.9 days, p = 0.69). All patients survived to discharge. In conclusion, there were no substantial differences between bolus injection and continuous infusion of equal doses of furosemide for the treatment of patients hospitalized with heart failure. Given the high prevalence of heart failure hospitalization and the disparate results of small studies regarding optimal dosing of loop diuretics to treat these patients, larger multicenter blinded studies are needed.

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Section: Discussionmentioning

confidence: 99%

Continuous Versus Bolus Dosing of Furosemide for Patients Hospitalized for Heart Failure

Allen

Turer

DeWald

et al. 2010

The American Journal of Cardiology

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“…A strategy could be to administer furosemide continuously and intravenously, allowing stable tubular drug delivery. Indeed, some studies report continuous furosemide infusion to be more effective to reduce ECFV in heart failure and severe fluid overload (118,128). A large study in heart failure patients, however, was unable to demonstrate that continuous intravenous furosemide was more effective in decreasing volume overload than bolus injections (46).…”

Section: What Determines the Braking Phenomenon And Is There A Fundammentioning

confidence: 99%

Everything we always wanted to know about furosemide but were afraid to ask

Huang

Mees

Vos

et al. 2016

American Journal of Physiology-Renal Physiology

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Huang X, Dorhout Mees E, Vos P, Hamza S, Braam B. Everything we always wanted to know about furosemide but were afraid to ask. Am J Physiol Renal Physiol 310: F958 -F971, 2016. First published February 24, 2016 doi:10.1152/ajprenal.00476.2015.-Furosemide is a widely used, potent natriuretic drug, which inhibits the Na ϩ -K ϩ -2Cl Ϫ cotransporter (NKCC)-2 in the ascending limb of the loop of Henle applied to reduce extracellular fluid volume expansion in heart and kidney disease. Undesirable consequences of furosemide, such as worsening of kidney function and unpredictable effects on sodium balance, led to this critical evaluation of how inhibition of NKCC affects renal and cardiovascular physiology. This evaluation reveals important knowledge gaps, involving furosemide as a drug, the function of NKCC2 (and NKCC1), and renal and systemic indirect effects of NKCC inhibition. Regarding renal effects, renal blood flow and glomerular filtration rate could become compromised by activation of tubuloglomerular feedback or by renin release, particularly if renal function is already compromised. Modulation of the intrarenal renin angiotensin system, however, is ill-defined. Regarding systemic effects, vasodilation followed by nonspecific NKCC inhibition and changes in venous compliance are not well understood. Repetitive administration of furosemide induces short-term (braking phenomenon, acute diuretic resistance) and long-term (chronic diuretic resistance) adaptations, of which the mechanisms are not well known. Modulation of NKCC2 expression and activity in kidney and heart failure is ill-defined. Lastly, furosemide's effects on cutaneous sodium stores and on uric acid levels could be beneficial or detrimental. Concluding, a considerable knowledge gap is identified regarding a potent drug with a relatively specific renal target, NKCC2, and renal and systemic actions. Resolving these questions would increase the understanding of NKCCs and their actions and improve rational use of furosemide in pathophysiology of fluid volume expansion. extracellular fluid volume; natriuresis; renal function; chronic kidney disease; heart failure DIURETICS BLOCKING THE Na ϩ -K ϩ -2Cl Ϫ cotransporter (NKCC) have an important place in the treatment of fluid overload, specifically in the context of kidney disease and heart failure (64). Of the drugs that inhibit the NKCC2 in the loop of Henle (furosemide, bumetanide, torsemide, ethacrynic acid), furosemide is most commonly applied (66) and Ͼ40 million prescriptions are dispensed every year in the USA (66a). However, many uncertainties remain about intrarenal and systemic actions of furosemide, including its two main targets NKCC1 and NKCC2.Clinically, there are a number of undesirable consequences of the use of furosemide, of which the pathophysiological mechanisms have not been sufficiently investigated. Furosemide has been associated with worsening of kidney function in patients treated for volume overload admitted for acute heart failure (104) and even glomerular filtration rate (GFR) ...

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“…In spite of that, furosemide CRI produced significantly greater diuresis and natriuresis than bolus injections; there were no significant differences in sideeffects including hypovolaemia, electrolyte disturbances, hyperuricaemia and metabolic alkalosis between the two methods (Lahav et al 1992). Ostermenn et al (2007) also noted similar findings in another diuretic study using CRI furosemide and bolus therapy, where no differences in terms of mortality and changes in renal function were found (Ostermann et al 2007).…”

Section: Day 1 Daymentioning

confidence: 81%

Comparison of continuous versus intermittent furosemide administration in dogs with acute heart failure

2016

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Pulmonary oedema is a life-threatening condition which should be treated promptly in the emergency room with oxygen, cage rest, and diuretic therapy. Traditionally, bolus administration of furosemide is the treatment of choice. However, there is emerging information that continuous rate infusion might be more effective than bolus injections in relieving clinical signs and producing a lower rate of complications such as azotaemia, dehydration, and electrolyte imbalances. We tested the effect of furosemide both in bolus (4-6 mg/kg intravenously) and continuous rate infusion (1 mg/kg/h) in 30 dogs that had been presented with fulminant pulmonary oedema during 2 days of hospitalization. No differences in the selected biochemical indicators between the groups were found. There were significant differences in blood urea nitrogen in the bolus injection group and creatinine and phosphorus in the continuous rate infusion group between days 1 and 2. The results of this study showed no differences in the approach of furosemide administration in the management of pulmonary oedema. Both methods may cause renal and electrolyte complications, however, further studies with a larger number of patients are recommended. Diuretics, canine, continuous rate infusion, pulmonary oedema

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Frusemide Administration in Critically Ill Patients by Continuous Compared to Bolus Therapy

Cited by 44 publications

References 55 publications

Continuous Versus Bolus Dosing of Furosemide for Patients Hospitalized for Heart Failure

Continuous Versus Bolus Dosing of Furosemide for Patients Hospitalized for Heart Failure

Everything we always wanted to know about furosemide but were afraid to ask

Comparison of continuous versus intermittent furosemide administration in dogs with acute heart failure

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