title: Diuretics in normotensive patients with acute pulmonary embolism and right ventricular dilatation.
abstract: BACKGROUND
  The benefit of load expansion is controversial in acute pulmonary embolism (PE). The aim of this study was to evaluate the benefit of furosemide in cases of normotensive acute PE.
  
  
  RESULTS
  We retrospectively included 70 consecutive normotensive patients (systolic blood pressure ≥ 90 mmHg) admitted for acute PE with right ventricular dilation. Overall, 40 patients were treated during the first 24h by repeated bolus of furosemide (78 ± 42 mg, range 40-160 mg) and 30 patients received isotonic saline solution (1.6 ± 0.9L). Severity of hemodynamic status was similar in both groups, but patients in the furosemide group were older and had a greater creatinine level. At 24h, only the furosemide group had a decreased shock index (0.82 ± 0.22 vs. 0.63 ± 0.16, P<0.0001) with improved systolic blood pressure (118 ± 18 vs. 133 ± 17 mmHg, P<0.0001), and creatinine levels. After treatment, there were fewer patients with simplified pulmonary embolism severity index ≥ 1 in the diuretic group (45% vs. 55%, P=0.03) than in the fluid expansion group (47% vs. 40%, P<0.0001). Finally, oxygen requirement at 24h decreased only in the diuretic group (75% to 47%, P=0.0004), and in-hospital survival without death and PE-related shock were similar between the 2 groups.
  
  
  CONCLUSIONS
  In normotensive PE with RV dilatation, diuretics may improve hemodynamics and oxygenation requirement.
authors.affiliation: APHP, Cardiovascular Department and INSERM U955, Team 3, Henri Mondor University Hospital.
authors.forename: Julien
authors.initials: J
authors.lastname: Ternacle
authors.forename: Romain
authors.initials: R
authors.lastname: Gallet
authors.forename: Armand
authors.initials: A
authors.lastname: Mekontso-Dessap
authors.forename: Guy
authors.initials: G
authors.lastname: Meyer
authors.forename: Bernard
authors.initials: B
authors.lastname: Maitre
authors.forename: Alexandre
authors.initials: A
authors.lastname: Bensaid
authors.forename: Priscille
authors.initials: P
authors.lastname: Jurzak
authors.forename: Pascal
authors.initials: P
authors.lastname: Gueret
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Dubois Randé
authors.forename: Pascal
authors.initials: P
authors.lastname: Lim
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000187:drug effects*; D004108:Dilatation, Pathologic / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D004232:Diuretics / Q000008:administration & dosage*; D005260:Female; D005665:Furosemide / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D018497:Ventricular Dysfunction, Right / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology
chemical_list: D004232:Diuretics; D005665:Furosemide