Frusemide in pulmonary oedema: continuous versus intermittent

Makhoul, Nicola; Riad, T.; Friedstrom, Scott; Zveibil, Fabio

doi:10.1080/714029042

Cited by 6 publications

(10 citation statements)

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“…Several recent randomised controlled trials (RCTs) have investigated the efficacy and safety profiles of modes of administration (continuous infusion vs. bolus) of i.v. furosemide in heart failure populations, but results have been conflicting . Continuous infusion of furosemide is believed to confer additional benefits over bolus injection, with less variability in peak plasma furosemide concentration resulting in a consistent, predictable urine output and less risk of electrolyte disturbance.…”

Section: Introductionmentioning

confidence: 78%

“…The clinical characteristics of all included RCTs comparing the outcomes of continuous infusion and bolus injection of furosemide in heart failure are presented in Table . Out of the eight studies, three studies were double‐blind , two studies were single‐blind , two studies were unblinded and one study was rated as ‘unclear’ due to insufficient information given in the manuscript. Two studies were of the heart failure population in intensive care , one study was of the heart failure population in the emergency department , and the rest of the included studies were of the heart failure population in hospital wards.…”

Section: Resultsmentioning

confidence: 99%

“…Out of the eight studies, three studies were double‐blind , two studies were single‐blind , two studies were unblinded and one study was rated as ‘unclear’ due to insufficient information given in the manuscript. Two studies were of the heart failure population in intensive care , one study was of the heart failure population in the emergency department , and the rest of the included studies were of the heart failure population in hospital wards. Overall, the majority of the included studies had low risk of bias, with the exception of two studies in which all patients received a bolus injection of furosemide 40 mg before random allocation to either continuous infusion or intermittent bolus injection of furosemide (see also Supporting Information, Table S4).…”

Section: Resultsmentioning

confidence: 99%

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Continuous infusion vs. intermittent bolus injection of furosemide in acute decompensated heart failure: systematic review and meta‐analysis of randomised controlled trials

Yap

2017

Anaesthesia

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Loop diuretics remain a fundamental pharmacological therapy to remove excess fluid and improve symptom control in acute decompensated heart failure. Several recent randomised controlled trials have examined the clinical benefit of continuous vs. bolus furosemide in acute decompensated heart failure, but have reported conflicting findings. The aim of this review was to compare the effects of continuous and bolus furosemide with regard to mortality, length of hospital stay and its efficacy profile in acute decompensated heart failure. All parallel-arm randomised controlled trials from MEDLINE, EMBASE, PubMed and the Cochrane Database of Systematic Reviews from inception until May 2017 were included. Cross-over randomised controlled trials, observational studies, case reports, case series and non-systematic reviews that involved children were excluded. Eight trials (n = 669) were eligible for inclusion. There was no difference between furosemide continuous infusion and bolus administration for all-cause mortality (four studies; n = 491; I = 0%; OR 1.65; 95%CI 0.93-2.91; p = 0.08) or duration of hospitalisation (six studies; n = 576; I = 71%; mean difference 0.27; 95%CI -1.35 to 1.89 days; p = 0.74). Continuous infusion of intravenous furosemide was associated with increased weight reduction (five studies; n = 516; I = 0%; mean difference 0.70; 95%CI 0.12-1.28 kg; p = 0.02); increased total urine output in 24 h (four studies; n = 390; I = 33%; mean difference 461.5; 95%CI 133.7-789.4 ml; p < 0.01); and reduced brain natriuretic peptide (two studies; n = 390; I = 0%; mean difference 399.5; 95%CI 152.7-646.3 ng.l ; p < 0.01), compared with the bolus group. There was no difference in the incidence of raised creatinine and hypokalaemia between the two groups. In summary, there was no difference between continuous infusion and bolus of furosemide for all-cause mortality, length of hospital stay and electrolyte disturbance, but continuous infusion was superior to bolus administration with regard to diuretic effect and reduction in brain natriuretic peptide.

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Section: Introductionmentioning

confidence: 78%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Continuous infusion vs. intermittent bolus injection of furosemide in acute decompensated heart failure: systematic review and meta‐analysis of randomised controlled trials

Yap

2017

Anaesthesia

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“…Clinicians could increase the dose every 2 h PRN to keep urine output greater than 1 mL/kg/h. Patients randomized to continuous infusion plus albumin received furosemide at same infusion rate, but the furosemide was mixed into a solution of albumin, 12.5 g albumin per 250 mg of furosemide [ 21 ].…”

Section: Resultsmentioning

confidence: 99%

Colloids to improve diuresis in critically ill patients: a systematic review

Oczkowski

Mazzetti

2014

j intensive care

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BackgroundThe background of this study is to determine whether the addition of intravenous colloid to diuretic therapy, in comparison to diuretic therapy alone, improves diuresis and oxygenation and prevents intravascular volume depletion in intensive care unit (ICU) patients without shock.MethodsWe searched MEDLINE, Embase, Cochrane Register of Controlled Trials, Google Scholar, conference abstracts of ACCP, SCCM, ATS, and references of relevant articles. Randomized controlled trials (RCTs) of adult ICU patients, not in shock (defined as patients on low dose or no vasopressors, without need for IV fluid bolus or blood transfusion within 24 h), comparing intravenous colloid therapy (human albumin, plasma, synthetic starches, or gels) plus diuretic to control (diuretic alone, or diuretic plus placebo). Two reviewers independently applied eligibility criteria, assessed quality, and extracted data.ResultsSeven hundred fifty five studies were found in the initial search; 14 were deemed relevant; 2 were found to be eligible. There was good agreement between reviewers for study relevance (k = 0.869) and eligibility (k = 0.811). One study of heart failure patients showed no evidence of improved mean or hourly urine output in the group receiving albumin. The second studied patients hypoproteinemic with ARDS and demonstrated an improved fluid balance in 3 days, improved oxygenation status, and improved serum albumin level in patients treated with albumin. No significant differences were found for other outcomes. No studies evaluating colloids other than albumin were found.ConclusionsOur review is limited by the small number of high-quality RCTs available to study this clinical question, both of which only studied albumin. High-quality RCTs are required to evaluate the effect of albumin as well as other colloids as an adjunct to diuresis in a general ICU population.Electronic supplementary materialThe online version of this article (doi:10.1186/2052-0492-2-37) contains supplementary material, which is available to authorized users.

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“…Although therapy with nesiritide has gained popularity in HF therapy in recent years, most patients who respond do well with conventional diuretic therapy. Furosemide as a continuous infusion is more effective than bolus therapy [6]. Zaroxolyn usually is added to augment the response of the continuous infusion of furosemide.…”

Section: Preoperative Evaluation Of Patients Who Have Heart Failurementioning

confidence: 99%