Continuous infusion versus intermittent bolus furosemide in ADHF: An updated meta-analysis of randomized control trials

被引:15
作者
Amer, Muhammad [1 ]
Adomaityte, Jurga [2 ]
Qayyum, Rehan [1 ]
机构
[1] Johns Hopkins Sch Med, Hospitalist Program, Div Gen Internal Med, Baltimore, MD USA
[2] Sinai Johns Hopkins Univ, Internal Med Residency Program, Sinai Hosp Baltimore, Baltimore, MD USA
关键词
HIGH-DOSE FUROSEMIDE; CONGESTIVE-HEART-FAILURE; LOOP DIURETICS; INJECTION; FRUSEMIDE; DIURESIS; QUALITY;
D O I
10.1002/jhm.991
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVE: Administering intermittent boluses of furosemide to patients with acute decompensated heart failure (ADHF) often leads to unfavorable hemodynamic changes. Continuous infusion may induce similar or greater diuresis without adverse hemodynamic consequences. We conducted a systemic review and meta-analysis of randomized clinical trials that compared the effects of continuous infusion and intermittent bolus of furosemide in patients hospitalized with ADHF. METHODS: We searched PubMed, EMBASE, and The Cochrane Central Register of Controlled Trials databases from their inception until March 2011. Two investigators independently abstracted data on study characteristics, quality, and selected outcomes. Differences between investigators were resolved by mutual consensus. Comparisons were reported as the weighted mean difference (WMDs). RESULTS: Ten trials involving a total of 564 patients were included. When administered as a continuous infusion, furosemide resulted in greater diuresis (WMD, -240.54 mL/24 hours/100 mg furosemide; 95% confidence interval [CI], -462.42 to -18.66) and reduction in total body weight (WMD, -0.78 kg; 95% CI, -1.54 to -0.03), than when administered in intermittent boluses. Urinary sodium excretion (WMD, -20.26 mmol/24 hours; 95% CI, -60.48 to 19.96) and duration of hospital stay (WMD, 0.99 days; 95% CI, -2.08 to 4.06) were not different between the 2 groups. CONCLUSION: This meta-analysis showed statistical support for administering furosemide as a continuous infusion for greater diuresis and reduction in total body weight in patients hospitalized with ADHF. With the exception of greater diuresis, available data are homogenous for the reported outcomes but lack information on clinical endpoints. Larger studies are needed to provide robust recommendations for clinical practice. Journal of Hospital Medicine 2012; 7: 270-275. (C) 2011 Society of Hospital Medicine.
引用
收藏
页码:270 / 275
页数:6
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