TY - JOUR
T1 - Protocol-guided diuretic management
T2 - Comparison of furosemide by continuous infusion and intermittent bolus
AU - Schuller, Dan
AU - Lynch, John P.
AU - Fine, Donna
PY - 1997
Y1 - 1997
N2 - Objective: To evaluate the safety and relative effectiveness of two diuretic protocols in the intensive care unit (ICU). Design: Prospective, randomized comparative study. Patients: Thirty-three cardiac and medical ICU patients with pulmonary edema or fluid overload for which aggressive diuresis was intended. Interventions: Enrolled patients were randomized to fluid management strategies combining fluid restriction and individually adjusted diuretic therapy by either continuous or bolus infusions of furosemide, titrated to achieve negative hourly fluid balance. Measurements and Main Results: Cumulative intake minus output (primary endpoint); change in serum creatinine, and length of ICU and hospital stay (secondary endpoints). Diuresis by either protocol was feasible, safe, and effective. The main outcome measures were not significantly different for either group managed with a standardized protocol. Conclusions: Protocol-guided diuretic management, with individualized titration of dosage to defined physiologic endpoints can be readily and safely implemented in the ICU. Both continuous and bolus diuretic regimens appear equally effective in achieving negative fluid balance. Larger studies with a randomized control arm are needed before these protocols can be recommended as routine practice.
AB - Objective: To evaluate the safety and relative effectiveness of two diuretic protocols in the intensive care unit (ICU). Design: Prospective, randomized comparative study. Patients: Thirty-three cardiac and medical ICU patients with pulmonary edema or fluid overload for which aggressive diuresis was intended. Interventions: Enrolled patients were randomized to fluid management strategies combining fluid restriction and individually adjusted diuretic therapy by either continuous or bolus infusions of furosemide, titrated to achieve negative hourly fluid balance. Measurements and Main Results: Cumulative intake minus output (primary endpoint); change in serum creatinine, and length of ICU and hospital stay (secondary endpoints). Diuresis by either protocol was feasible, safe, and effective. The main outcome measures were not significantly different for either group managed with a standardized protocol. Conclusions: Protocol-guided diuretic management, with individualized titration of dosage to defined physiologic endpoints can be readily and safely implemented in the ICU. Both continuous and bolus diuretic regimens appear equally effective in achieving negative fluid balance. Larger studies with a randomized control arm are needed before these protocols can be recommended as routine practice.
KW - Diuretic management
KW - Fluid management
KW - Furosemide
KW - Protocol-guided therapy
KW - Pulmonary edema
UR - http://www.scopus.com/inward/record.url?scp=0031456487&partnerID=8YFLogxK
U2 - 10.1097/00003246-199712000-00011
DO - 10.1097/00003246-199712000-00011
M3 - Article
C2 - 9403744
AN - SCOPUS:0031456487
SN - 0090-3493
VL - 25
SP - 1969
EP - 1975
JO - Critical care medicine
JF - Critical care medicine
IS - 12
ER -