Comparison of continuous versus intermittent furosemide administration in postoperative pediatric cardiac patients.
OBJECTIVE
To compare the effects of furosemide administered by intermittent iv infusion vs. continuous iv infusion on urine output, hemodynamic variables, and serum electrolyte concentrations.


METHODS
Prospective, randomized trial.


METHODS
Pediatric ICU.


METHODS
Postoperative pediatric cardiac patients.


METHODS
Patients were assigned to either the continuous iv infusion or the intermittent infusion groups. The intermittent group received 1 mg/kg iv of furosemide every 4 hrs to be increased by 0.25 mg/kg iv every 4 hrs to a maximum of 1.5 mg/kg iv if the urine output was less than 1 mL/kg.hr. The continuous infusion group received an initial furosemide dose of 0.1 mg/kg iv (minimum 1 mg) followed by an iv infusion rate of 0.1 mg/kg.hr of furosemide to be doubled every 2 hrs to a maximum of 0.4 mg/kg.hr if the urine output was less than 1 mL/kg.hr.


RESULTS
Demographic variables, fluids, electrolyte and inotropic requirements were the same in both groups. A significantly (p = .045) lower daily dose of furosemide (4.90 +/- 1.78 vs. 6.23 +/- 0.62 mg/kg.day) in the continuous iv infusion group produced the same 24-hr urine volume as that of the intermittent group. There was more variability in urine output in the intermittent group as well as more urinary losses of sodium (0.29 +/- 0.15 vs. 0.20 +/- 0.06 mmol/kg.day, p = .0007) and chloride (0.40 +/- 0.20 vs. 0.30 +/- 0.12 mmol/kg.day, p = .045).


CONCLUSIONS
Furosemide administered by continuous iv infusion is advantageous in the post-operative pediatric patient because of a more controlled and predictable urine output with less drug requirement and less urinary loss in sodium and chloride.
Singh
N C
NC
Children's Hospital, Western Ontario, London, Canada.
Kissoon
N
N
al Mofada
S
S
Bennett
M
M
Bohn
D J
DJ
D006348:Cardiac Surgical Procedures; D002675:Child, Preschool; D004573:Electrolytes / Q000097:blood / Q000737:chemistry; D005260:Female; D005665:Furosemide / Q000008:administration & dosage* / Q000494:pharmacology / Q000627:therapeutic use; D006330:Heart Defects, Congenital / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007262:Infusions, Intravenous / Q000379:methods* / Q000592:standards; D015278:Intensive Care Units, Pediatric; D008297:Male; D011184:Postoperative Period; D011446:Prospective Studies; D014556:Urine / Q000737:chemistry; D014882:Water-Electrolyte Balance / Q000187:drug effects
D004573:Electrolytes; D005665:Furosemide