Critical Care Medicine | 2019
927: CONTINUOUS VERSUS BOLUS INFUSION OF FUROSEMIDE A META-ANALYSIS OF PARALLEL-GROUP RANDOMIZED TRIALS
Abstract
Learning Objectives: Fluid overload impairs organ function and increases mortality. Diuretic therapy is thus important in critically ill patients. The efficacy of continuous and bolus administration of furosemide has been repeatedly compared. However, many of previous studies on this topic represented crossover trials without appropriate washout periods, in which the diuretic effect and resistance were carried over to the other phase and patient-oriented outcomes were insufficiently discussed. Further, this issue has been examined in a diversity of disease populations in terms of diuretic resistance. Parallel-group randomized trials in a specific disease population to examine patient-orient outcomes are clinically relevant. Consequently, we conducted a meta-analysis of parallel-group randomized controlled trials to compare these two strategies in adults with acute decompensated heart failure (ADHF). Methods: We searched Medline, EMBASE, and the Cochrane Central Register of Controlled Trials from their inceptions to May 26, 2018. We included parallel-group randomized controlled trials that compared continuous and bolus administration of furosemide in patients with ADHF. Our primary outcomes were allcause mortality, length of hospital stay, and body weight reduction. Our secondary outcomes include 24-hour urine output and adverse events. We pooled the data using a random-effects model. Results: We included 12 parallel-group randomized controlled trials involving 923 patients in our analysis. Compared with intermittent administration, continuous infusion of furosemide was not associated with an improvement in all-cause mortality (risk ratio 1.19; 95% confidence interval [CI], 0.65 to 2.16) or length of hospital stay (weighted mean difference [WMD] -0.88 days; 95% CI, -2.76 to 1.01), but was significantly associated with a greater body weight reduction (WMD 0.63 kg; 95% CI, 0.23 to 1.02). Continuous infusion of furosemide may be associated with a greater 24-hour urine output (WMD 489.17 mL; 95% CI, -183.18 to 1161.51) in comparison with the bolus infusion. No differences in hypokalemia, hyponatremia, increased serum creatinine level, and hypotension were noted. Conclusions: Continuous infusion of furosemide, compared to the bolus counterpart, is associated with a greater body weight reduction and potential increase in 24-hour urine output. The limited available evidence suggests no difference in adverse events between both strategies.