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A Retrospective Analysis of Intermittent Bolus Dosing Versus Continuous Infusion Dosing of Furosemide in Critical Care Patients With Diuretic Resistance FREE TO VIEW

Elizabeth Hawkins*, PharmD; Mark Malesker, PharmD; Daniel Hilleman, PharmD; Lee Morrow, MD
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Creighton University, Omaha, NE

Chest. 2012;142(4_MeetingAbstracts):402A. doi:10.1378/chest.1390353
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SESSION TYPE: Pharmacology in the ICU Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: To evaluate the short-term efficacy and safety of continuous intravenous furosemide infusions compared to intermittent bolus dosing of furosemide in critically ill patients with diuretic resistance.

METHODS: Retrospective review of the records of 100 consecutive diuretic resistant ICU patients (urine output <0.5 ml/kg/hr despite >200 mg/day furosemide) compared baseline characteristics and short-term clinical outcomes of patients treated with conventional bolus dosing of furosemide to those of patients treated with continuous infusion furosemide. The primary outcome measured the magnitude of diuresis during the time furosemide was infused parenterally.

RESULTS: 63 patients received furosemide infusion while 37 received bolus therapy. There were no differences in baseline demographics or clinical characteristics for infusion- vs. bolus-treated patients. Patients were treated with similar durations of therapy (3.5 infusion vs. 3.1 bolus days, p=0.28). Infusion-treated patients had higher baseline APACHE II scores (18.3 vs. 15.6, p=0.01). During the first seven days of therapy, infusion patients had significantly larger net diuresis (-5,964 vs. -3,498 mL, p=0.003), significantly larger changes in serum potassium (-0.47 vs. -0.20 mEq/dL, p=0.03) and a trend toward increased creatinine values (0.09 vs. -0.03 mg/dL, p=0.08) when compared to bolus patients. Although there were numerically more diuretic-related adverse events in bolus-treated patients, these differences were not statistically significant (23.8% vs. 43.0%, p=0.57). There were no observed differences in ICU length of stay (14.0 vs. 8.9 days, p=0.13), hospital length of stay (23.0 vs. 19.9 days, p=0.28), or mortality (10.8 vs. 14.2%, p=0.60) between groups.

CONCLUSIONS: Continuous infusion of furosemide has significantly greater efficacy than bolus dosing of furosemide in patients with diuretic resistance without an increase in adverse events.

CLINICAL IMPLICATIONS: The results of this study suggest that continuous infusion of furosemide would be a more effective strategy than bolus dosing in patients with diuretic resistance, without a subsequent increase in adverse events.

DISCLOSURE: The following authors have nothing to disclose: Elizabeth Hawkins, Mark Malesker, Daniel Hilleman, Lee Morrow

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Creighton University, Omaha, NE




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