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Continuous infusion versus bolus injection of furosemide in critically ill patients.A systematic review and meta-analysis
1Department of Anesthesia and Intensive Care, Università Vita-Salute San Raffaele
2,Department of Anaesthesia and Intensive Care Istituto Scientifico San Raffaele
3,Interventional Cardiology Division of Cardiology Università di Torino
*Corresponding Author(s): LUCA CABRINI E-mail: cabrini.luca@hsr.it
Introduction. Fluid overload and a positive fluid balance are common in the intensive care unit (ICU). Furosemide is frequently administered to increase urine output. A bolus injection is the traditional mode of administration, but many concerns have been raised about possible intravascular volume fluctuations, toxicity and enhanced tolerance. Furosemide related adverse effects can be enhanced in critically ill patients. Continuous infusion should allow better hemodynamic stability, less side effects and an easier achievement of the desired diuretic effect. We performed a systematic review and meta-analysis to compare the effects and complications of continuous furosemide infusion with those of bolus injections in critically ill patients in the ICU. Methods. Studies were searched in PubMed (updated January 2009). Backward snowballing of included papers was per-formed. International experts were contacted for further studies.
The inclusion criteria were: random allocation to treatment, comparison of furosemide bolus vs continuous infusion, per-formed in surgical or intensive care patients. The exclusion criteria were: non-parallel design randomized trials, duplicate publications, non-human experimental studies, no outcome data.
Results. Four eligible randomized clinical trials were identified, including 129 patients (64 to continuous infusion and 65 to bolus treatment). Continuous perfusion was not associated with a significant reduction in risk of mortality as compared to bolus injection
Conclusions. Furosemide in continuous perfusion was not associated with a significant reduction in risk of hospital mortality as compared to bolus administration in critically ill patients in ICU, but existing data are insufficient to confidently assess the best way to administer furosemide . Applying a protocol to drive furosemide therapy could be more relevant than the chosen mode of administration.
furosemide, kidney Fai-lure, intensive care, drug therapy, meta-analysis, diuretics
ALBERTO ZANGRILLO,LUCA CABRINI,GIACOMO MONTI,TURI STEFANO,ELENA MOIZO,FEDERICO VINCIGUERRA,GIOVANNA FRAU,GIUSEPPE G BIONDI-ZOCCAI. Continuous infusion versus bolus injection of furosemide in critically ill patients.A systematic review and meta-analysis. Signa Vitae. 2011. 6(2);58-63.
1. Schuller D, Mitchell JP, Calandrino FS, Schuster DP. Fluid balance during pulmonary edema: is fluid gain a marker or a cause of poor outcome? Chest 1991;100:1068-75.
2. Simmons RS, Berdine GG, Seidenfeld JJ, Prihoda TJ, Harris GD, Smith JD, et al. Fluid balance and the adult respiratory syndrome. Am Rev Respir Dis 1987;135:924-9.
3. Lowell JA, Schifferdecker C, Driscoll DF, Benotti PN, Bistrian BR. Postoperative fluid overload: Not a benign problem. Crit Care Med 1990:18:728-33.
4. Humprey H, Hall J, Sznajder I, Silverstein M, Wood L. Improved survival in ARDS patients associated with a reduction in pulmonary capillary wedge pressure. Chest 1990:97:1176-80.
5. Branck RA, Roberts CJC, Homeida M, Levine D. Determinants of response to furosemide in normal subject. Br J Clin Pharmacol 1977;4:121-7.
6. Hammarlund MM, Odlind B, Paalzow LK. Acute tolerance to furosemide diuresis in humans. J Pharmacol Exp Ther 1985;233:447-53.
7. van Meyel JJ, Smits P, Russel FG, Gerlag PG, Tan Y, Gribnau FW. Diuretic efficiency of furosemide during continuous administration versus bolus injection in healty volunteers. Clin Pharmacol Ther 1992;51:440-4.
8. Rudy DW, Voelker JR, Greene PK, Esparza FA, Brater DC. Loop diuretics for chronic renal insufficiency: a continuous infusion is more efficacious than bolus therapy. Ann Intern Med 1991;115:360-6.
9. Singh NC, Kissoon N, Mofada S, Bennet M, Bohn DJ. Comparison of continuous versus intermittent furosemide administration in posto-perative pediatric patients. Crit Care Med 1992;20:17-21.
10. Dormans TP, van Meyel JJ, Gerlag PG, Tan Y, Russel FG, Smits P. Diuretic efficacy of high dose furosemide in severe hear failure : bolus injection versus continuous infusion. J Am Coll Cardiol 1996;28:376-82.
11. Salvador DRK, Rey NR, Ramos GC, Punzalan FE. Continuous infusion versus bolus injection of loop diuretics in congestive heart failure. Cochrane database Syst Rev 2005:3:CDoo3178.
12. Metha RL, Pascual MT, Soroko S, Chertow GM. PICARD Study Group. Diuretics, mortality and nonrecovery of renal function in acute renal failure. JAMA 2002;288:2547-53.
13. Biondi-Zoccai GGL, Agostoni P, Abbate A, Testa L, Burzotta F. A simple hint to improve Robinson and Dickersin’s highly sensitive PubMed search strategy for controlled clinical trials. Int J Epidemiol 2005;34:224-5.
14. Ostermann M, Alvarez G, Scarpe MD, Martin MC. Frusemide administration in critically ill patients by continuous compared to bolus therapy. Nephron Clin Pract 2006;107:70-6.
15. Mojtahedzadeh M, Salehifar E, Vazin A, Mahidiani H, Najafi A, Tavakoli M, et al. Comparison of hemodynamic and biochemical effects of furosemide by continuous infusion and intermittent bolus in critically ill patients. J Infus Nurs 2004;27:255-61.
16. Schuller D, Lynch JP, Fine D. Protocol-guided diuretic management: comparison of furosemide by infusion and intermittent bolus. Crit Care Med 1999;25:1969-75.
17. Copeland JG, Campbell DW, Plachetka JR, Salomon NW, Larson DF. Diuresis with continuous infusion of furosemide after cardiac surgery. Am J Surg 1983;146:796-9.
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