Continuous versus bolus furosemide therapy in critically ill patients with fluid overload

Loop diuretics are commonly used in critically ill patients with fluid overload and/or renal failure. Our objective was to compare the effects of furosemide administered by intermittent intravenous (i.v.) boluses versus continuous i.v. infusion on urine output and furosemide requirement. In an open randomised controlled fashion, 59 fluid overloaded adult patients in two University hospital mixed intensive care units were randomised to a treatment algorithm using either continuous (n = 32 patients) or bolus (n = 27 patients) furosemide to achieve a minimum hourly urine output. At baseline there was no significant difference in age, gender, hourly urine output, creatinine clearance, APACHE II score and number of ventilated patients between the two groups. Algorithm-driven diuresis was equally efficacious using bolus or infusion furosemide but the total dosage of furosemide required was significantly less using continuous infusion therapy (Fig.). There were no significant differences in hospital mortality and the need for renal replacement therapy.

Figure

We conclude that continuous infusion of furosemide may be easier to manage and expose patients to a lower dose, potentially avoiding or reducing adverse events.