Abstract
Background
It is unclear whether fluid management goals are best achieved by bolus injection
or continuous infusion of loop diuretics. In this study, we compared the effectiveness
and safety of a continuous infusion with that of a bolus injection when an increased
loop diuretic dosage is required in intensive care unit (ICU) patients.
Methods
We obtained data from the MIMIC-III database for patients who were first-time ICU
admissions and required an increased diuretic dosage. Patients were excluded if they
had an estimated glomerular filtration rate <15 ml/min/1.73 m2, were receiving renal replacement therapy, had a baseline systolic blood pressure
<80 mmHg, or required a furosemide dose <120 mg. The patients were divided into a
continuous group and a bolus group. Propensity score matching was used to balance
patients’ background characteristics.
Results
The final dataset included 807 patients (continuous group, n = 409; bolus group, n = 398). After propensity score matching, there were 253 patients in the bolus group
and 231 in the continuous group. The 24 h urine output per 40 mg of furosemide was
significantly greater in the continuous group than in the bolus group (234.66 ml [95%
confidence interval (CI) 152.13–317.18, p < 0.01]). There was no significant between-group difference in the incidence of acute
kidney injury (odds ratio 0.96, 95% CI 0.66–1.41, p = 0.85).
Conclusions
Our results indicate that a continuous infusion of loop diuretics may be more effective
than a bolus injection and does not increase the risk of acute kidney injury in patients
who need an increased diuretic dosage in the ICU.
Keywords
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Article info
Publication history
Published online: December 23, 2022
Accepted:
December 14,
2022
Received:
December 4,
2021
Identification
Copyright
© 2022 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
