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
DOI: 10.22514/SV62.102011.8 Vol.6,Issue 2,October 2011 pp.58-63
Published: 31 October 2011
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.
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