PURPOSE: Anasarca of critical illness may be associated with poor outcomes. Diuresis decreases duration of mechanical ventilation and reduces length of stay. We implemented a protocol for continuous infusion of furosemide to expedite a negative fluid balance in the severely edematous patient.
METHODS: Prospective cohort study of patients admitted to the Respiratory ICU at LDS Hospital from June 2003-July 2004. Consecutive patients who received continuous furosemide infusions were included. Exclusion criteria were shock or renal failure (creatinine clearance <50 or receiving hemodialysis). Continuous furosemide was administered by protocol with a net negative fluid balance goal of 3-5 liters per day. Furosemide was discontinued for clinical or electrolyte instability.
RESULTS: There were 43 patients with a mean age of 66.2±14.5 years, 58% were male, the mean APACHE II Score on protocol day 1 was 18.6±4.4, and duration of mechanical ventilation was 30.7±14.9 days. The mean time on furosemide infusion was 4.9±2.6 days (range 1 to 11 days). The average net fluid balance for a full day (>18 hours) of furosemide infusion was −3073±1271 ml (median −2893 ml), partial day (1-18 hours) of furosemide infusion was −1887±1437 ml (median −1938 ml), and with no fursoemide infusion was 249±799 ml (median −273 ml). Two percent of patient days had potassium values in the low critical range (<3.0 mmol/L) and 1% in the high critical range (>6 mmol/L). No magnesium or sodium values fell in the critical range. The change in renal function with furosemide influsion (post minus pre) was 0.8±10.6 mg/dL for BUN and 0.1±0.4 mg/dL for creatine. Furosemide infusion was stopped 17 times for hypotension: 9 times in patients receiving a trial of diuresis despite known sepsis, 6 times in patients with newly unmasked sepsis, and 2 patients diuresed too fast.
CONCLUSION: Continuous infusion of furosemide is safe and effective for clearing the anasarca of critical illness, in patients without shock or renal failure.
CLINICAL IMPLICATIONS: Continuous furosemide influsion may allow earlier, safer, and more complete control of anasarca than bolus furosemide.
DISCLOSURE: Louise Bezdjian, None.