- Meeting abstract
Comparison between continuous versus bolus furosemide administration in oliguric postoperative paediatric cardiac patients
Critical Care volume 7, Article number: P223 (2003)
To compare the efficacy of continuous versus bolus furosemide administration on urinary output, sodium and furosemide excretion following paediatric cardiac surgery.
Prospective, double-blinded, randomised crossover study.
Fifteen infants with postoperative oliguria (urine volume < 1 ml/kg per hour) unresponsive to 10 ml/kg 0.9% saline bolus were enrolled in the study. Time of enrolment was between 16 and 24 hours post-PICU admission, which is the period of least ADH-mediated antidiuresis. Diagnostic groups included Tetralogy of Fallots (n = 7), Norwood Stage 1 (n = 2), VSD and arch repair (n = 2), and other (n = 4).
Patients were randomly assigned to receive an equivalent dose of furosemide either as a single bolus dose (1 mg/kg) with a placebo saline infusion or a continuous furosemide infusion (0.2 mg/kg bolus followed by 0.125 mg/kg per hour) and studied over a 6 hour period. After a 2 hour 'washout' period, the patients were crossed over and the study repeated with the alternative administration method. Urine was collected every 2 hours for electrolytes and urinary furosemide concentration (measured by high-performance liquid chromatography) .
Measurements and results
The median age (IQ) was 4.1 months (0.1–7.6), weight 6.3 kg (3.5–7.1) and duration of cardiopulmonary bypass (n = 13) was 99 min (74–112).
Cumulative urine output (Fig. 1) and Na excretion were similar between both groups (ANOVA, P = 0.3) over the 6 hour study period. However, cumulative tubular furosemide excretion (Fig. 2) was significantly greater following furosemide bolus (ANOVA group effect, P < 0.02). Additionally, cumulative K excretion was similar between both treatment methods (ANOVA, P = 0.3). No differences were observed between treatment groups for the following haemodynamic parameters; heart rate (ANOVA, P = 0.9), mean BP (ANOVA, P = 0.9) or CVP (ANOVA, P = 0.8).
Furosemide administration by continuous infusion is effective as bolus therapy in its diuretic and natriuretic effects in oliguric infants following cardiac surgery. The continuous furosemide infusion produces a greater diuresis per urinary tubular furosemide concentration.
Mills J, et al.: Quantification of furosemide from serum and tissues using HPLC. J Chromatogr B 1997, 701: 65-70. 10.1016/S0378-4347(97)00341-1
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Taylor, D., Durward, A., Mayer, A. et al. Comparison between continuous versus bolus furosemide administration in oliguric postoperative paediatric cardiac patients. Crit Care 7, P223 (2003). https://doi.org/10.1186/cc2112
- Saline Bolus
- Single Bolus Dose
- Bolus Therapy
- Furosemide Administration