title: Frusemide administration in critically ill patients by continuous compared to bolus therapy.
abstract: BACKGROUND
  Frusemide is frequently administered to critically ill patients in the intensive care unit (ICU). We investigated whether continuous frusemide infusion therapy was more effective than regular intermittent bolus doses at causing diuresis.
  
  
  METHODS
  59 adult patients with fluid overload admitted to two tertiary multidisciplinary ICUs were randomised to either a continuous frusemide infusion or regular intermittent intravenous boluses of frusemide according to pre-defined algorithms aiming for a minimum hourly urine output.
  
  
  RESULTS
  There was no significant difference in diuretic response between the two groups during the first 24 h (5.3 liters in the bolus group vs. 5.4 liters in the infusion group). In the bolus group a significantly higher dose of frusemide was needed to achieve target diuresis (24.1 vs. 9.2 mg/h in the infusion group, p = 0.0002). Mean urine output per dose of frusemide was significantly higher in the infusion group (31.6 vs. 18 ml/mg in the bolus group, p = 0.014). At the end of the study, there were no differences in hospital mortality, number of patients requiring ventilatory support, change in serum creatinine or change in estimated glomerular filtration rate.
  
  
  CONCLUSIONS
  Both intermittent boluses and continuous infusion of frusemide were successful in achieving algorithm-driven diuresis. However, continuous infusion therapy was more effective than intermittent boluses since the dose of frusemide required was significantly less.
authors: Program in Critical Care, University of Western Ontario, London Health Sciences Centre, London, Ontario, Canada. marlies@ostermann.freeserve.co.uk
authors: Marlies
authors: M
authors: Ostermann
authors: George
authors: G
authors: Alvarez
authors: Michael D
authors: MD
authors: Sharpe
authors: Claudio M
authors: CM
authors: Martin
mesh_terms: D000368:Aged; D016638:Critical Illness / Q000453:epidemiology*; D004232:Diuretics / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005665:Furosemide / Q000008:administration & dosage*; D006801:Humans; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D007668:Kidney / Q000187:drug effects / Q000502:physiology; D008297:Male; D008875:Middle Aged
chemical_list: D004232:Diuretics; D005665:Furosemide