Article Data

  • Views 634
  • Dowloads 150

Original Research

Open Access

Continuous infusion versus bolus injection of furosemide in pediatric patients after cardiac surgery: a meta-analysis of randomized studies

  • ALBERTO ZANGRILLO1
  • LUCA CABRINI1
  • GIUSEPPE G. L. BIONDI-ZOCCAI2
  • GIACOMO MONTI1
  • STEFANO TURI1
  • IMAD SHEIBAN1
  • ELENA BIGNAMI1
  • GIOVANNI LANDONI1

1,Department of Anesthesia and Intensive Care Istituto Scientifico San Raffaele

2,Interventional Cardiology Division of Cardiology Università di Torino

DOI: 10.22514/SV71.042012.3 Vol.7,Issue 1,April 2012 pp.17-22

Published: 30 April 2012

*Corresponding Author(s): GIOVANNI LANDONI E-mail: landoni.giovanni@hsr.it

Abstract

Introduction. Acute renal failure and fluid retention are common problems in pediatric patients after cardiac surgery. Furosemide, a loop diuretic drug, is frequently administered to increase urinary output. The aim of the present study was to compare efficacy and complications of continuous infusion of furosemide vs bolus injection among pediatric patients after cardiac surgery.

Methods. A systematic review and meta-analysis was performed in compliance with The Cochrane Collaboration and the Quality of Reporting of Meta-Analysis (QUORUM) guidelines. The following inclusion criteria were employed for potentially relevant studies: a) random treatment allocation, b) comparison of furosemide bolus vs continuous infusion, c) surgical or intensive care pediatric patients. Non-parallel design randomized trials (e.g. cross-over), duplicate publications and non-human experimental studies were excluded.

Results. Up to August 2008, only three studies were found, with 92 patients randomized (50 to continuous infusion and 42 to bolus treatment). Overall analysis showed that continuous infusion and bolus administration were equally effective in achieving the predefined urinary output, and were associated with a similar amount of administered furosemide (WMD=-1.71 mg/kg/day [-5.20; +1.78], p for effect=0.34, p for heterogeneity<0.001, I2=99.0). However, in the continuous infu-sion group, patients had a significantly reduced urinary output (WMD=-0.48 ml/kg/day [-0.88; -0.08], p for effect=0.02, p for heterogeneity <0.70, I2=0%).

Conclusions. Existing data comparing furosemide bolus injection with a continuous infusion are insufficient to confidently assess the best way to administer furosemide to pediatric patients after cardiac surgery. Larger studies are needed before any recommendations can be made.

Keywords

furosemide, cardiac sur-gery, meta-analysis, intensive care unit, paediatric, acute kidney failure

Cite and Share

ALBERTO ZANGRILLO,LUCA CABRINI,GIUSEPPE G. L. BIONDI-ZOCCAI,GIACOMO MONTI,STEFANO TURI,IMAD SHEIBAN,ELENA BIGNAMI,GIOVANNI LANDONI. Continuous infusion versus bolus injection of furosemide in pediatric patients after cardiac surgery: a meta-analysis of randomized studies. Signa Vitae. 2012. 7(1);17-22.

References

1. Gailiunas P Jr, Chawla R, Lazarus JM, Cohn L, Sanders J, Merrill JP. Acute renal failure following cardiac operations. J Thorac Cadiovasc Surg 1980;79:241-3.

2. Baxter P, Rigby ML, Jones OHD, Lincoln C, Shinebourne EA. Acute renal failure following cardiopulmonary bypass in children: results of treatment. Int J Cardiol 1985;7:235-9.

3. 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.

4. 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

5. van Meyel JJ, Smits P, Russel FG, Gerlag PG, Tan Y, Gribnau FW. Diuretic efficiency of furosemide during continuous administration versus bolus injection in healthy volunteers. Clin Pharmacol Ther 1992;51:440-4.

6. Rudy DW, Voelker JR, Greene PK, Esparza FA, Brater DC. Loop diuretics for chronic renal insufficiency: a continuous infusion is more effi-cacious than bolus therapy. Ann Intern Med 1991;115:360-6.

7. Dormans TP, van Meyel JJ, Gerlag PG, Tan Y, Russel FG, Smits P. Diuretic efficacy of high dose furosemide in severe heart failure: bolus injection versus continuous infusion. J Am Coll Cardiol 1996;28:376-82.

8. Salvador DRK, Rey NR, Ramos GC, Punzalan FE. Continuous infusion versus bolus injection of loop diuretics in congestive heart failure. Cochrane Database of Systematic Review 2005:3:CD003178.

9. 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:C70-6.

10. 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.

11. 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.

12. 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.

13. Higgins JPT, Green S. eds Cochrane Handbook for Systematic Reviews of Interventions, Version 5.1.0 The Cochrane Collaboration, 2011. http://www.cochrane-handbook.org. Accessed February 4, 2012

14. McGinn TG, Guyatt GH, Cook R, Meade M. Diagnosis: measuring agreement beyond chance. In: Guyatt G, Rennie D, editors. Users’ guide to the medical literature. A manual for evidence-based clinical practice. Chicago, IL, USA: AMA Press; 2002:461-70.

15. Fleiss JL. The statistical basis of meta-analysis. Stat Methods Med Res 1993;2:121-45.

16. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003;327:557-60.

17. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315:629-34.

18. Singh NC, Kissoon N, Mofada S, Bennet M, Bohn DJ. Comparison of continuous versus intermittent furosemide administration in postope-rative pediatric patients. Crit Care Med 1992; 20:17-21.

19. Klinge JM, Shaki J, Hofbeck M, Gertlig S, Bonakdar S, Singer H. Intermittent administration of furosemide versus continuous infusion in the postoperative management of children following open heart surgery. Int Care Med 1997;23:693-7.

20. Luciani GB. Nichani S, Chang AC, Wells WJ, Newth CJL, Starnes VA. Continuous versus intermittent furosemide infusion in critically ill infants after open heart operations. Ann Thorac Surg 1997;64:1133-9.

21. Uchino S, Doig GS, Bellomo R, Morimatsu H, Morgera S, Schetz M, et al. Beginning and ending supportive therapy for the Kidney (B.E.S.T. Kidney) Investigator. Diuretics and mortality in acute renal failure. Crit Care Med 2004;32:1669-77.

22. Ho KM, Sheridan DJ. Meta-analysis of frusemide to prevent or treat acute renal failure. BMJ 2006:333-420.

23. Sampath S, Moran JL, Graham PL, Rockliff S, Bersten AD, Abrams KR. The efficacy of loop diuretics in acute renal failure: Assessment using Bayesian evidence synthesis techniques. Crit Care Med 2007;35:2516-24.

24. Basghaw SM, Belomo R, Kellum JA. Oliguria, volume overload and loop diuretics. Crit Care Med 2008;36(Suppl.):S172-S8.

25. 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.

26. Landoni G, Biondi-Zoccai GGL, Tumlin JA, Bove T, De Luca M, Calabrò MG, et al. Beneficial impact of fenoldopam in critically ill patients with or at risk for acute renal failure: a meta-analysis of randomized clinical trials. Am J Kidney Dis 2007;49:56-68.

27. Landoni G, Biondi-Zoccai GGL, Marino G, Bove T, Fochi O, Maj G, et al. Fenoldopam reduces the need for Renal Replacement Therapy and in-hospital death in cardiovascular surgery: a meta-analysis. J Cardiothorac Vasc Anesth 2008;22:27-33.

28. Martin SJ, Danziger LH. Continuous infusion of loop diuretics in the critically ill: a review of the literature. Crit Care Med 1994;22:1323-9.

29. Kaojarern S, Day B, Brater DC. The time course of delivery of furosemide into urine: An independent determinant of overall response. Kidney Int 1982;22:69-74.

30. Lee MG, Li T, Chiou WL. Effect of intravenous infusion time on the pharmacokinetics and pharmacodynamics of the same total dose of furosemide. Biopharm Drug Dispos 1986;7:537-47

31. Hammarlund MM, Odlind B, Paalzow LK. Acute tolerance to furosemide diuresis in humans. Journal of Pharmacology and Experimental Therapeutics 1985;233:447-53.

32. Biondi-Zoccai GG, Agostoni P, Abbate A. Parallel hierarchy of scientific studies in cardiovascular medicine. Ital Heart J 2003;4:819-20.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 0.5(2019) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time

Conferences

Top