Continuous infusion vs. intermittent bolus injection of furosemide in acute decompensated heart failure: systematic review and meta‐analysis of randomised controlled trials

Ng, Ka Ting; Yap, Jasmine Li Ling

doi:10.1111/anae.14038

Cited by 52 publications

(38 citation statements)

References 30 publications

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“…This study has demonstrated that increased weight loss by administering furosemide infusion is associated with improved outcomes, consistent with a previous study, 15 and a study conducted by Ng and Yap, 16 which showed a significant association between continuous infusion of furosemide and increased loss of body weight. It has been shown that increasing the dose of diuretic helps to maintain the therapeutic effect which is a major risk to diuretic resistance.…”

Section: Discussionsupporting

confidence: 91%

Effect of diuretic infusion clinic in preventing hospitalization for patients with decompensating heart failure

Alghalayini

2020

SAGE Open Medicine

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Introduction: It is proposed that access to administering intravenous furosemide outside the hospital can contribute to lowering hospital admissions for heart failure. This study aims to evaluate the effect of outpatient furosemide infusion protocol in preventing hospitalization for patients with decompensating heart failure. This constitutes designing a viable clinical pathway in hospitals using a multidisciplinary heart failure program. Methods: A prospective interventional study testing the effect of diuretic infusion clinic in preventing hospitalization for patients with decompensating heart failure was conducted on 150 decompensating heart failure patients requiring hospital admission. Only 105 patients met the criteria and subsequently enrolled in the study. Each patient was administered intravenous furosemide infusion one or more times according to the protocol and depending on their symptoms of decompensation. Patients were referred for admission at any point once there is no improvement of their medical condition, or referred to heart failure clinic when clinical picture improved as observed by the treating team. Results: In total, 14 of 105 patients who received intravenous furosemide infusion did not respond to diuretic infusion protocol and required hospital admission while 91 patients responded to same protocol and did not require admission, P value was statistically significant in three laboratory test measures of potassium (<0.001), urea (0.004), and creatinine (0.008). Heart failure with reduced ejection fraction was observed in 70 (76.9%) responders with a mean ejection fraction of 23% and in 9 (64.3%) non-responders with mean ejection fraction of 19.9%. Conclusion: Outpatient intravenous furosemide infusion protocol is effective in preventing hospitalization for decompensating heart failure and a viable clinical pathway for heart failure programs.

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Section: Discussionsupporting

confidence: 91%

Effect of diuretic infusion clinic in preventing hospitalization for patients with decompensating heart failure

Alghalayini

2020

SAGE Open Medicine

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“…Statistical analyses were undertaken using Review Manager version 5.3 (The Cochrane Collaboration, Copenhagen, Denmark). Analysis of funnel plots for primary and secondary outcomes (incidence of delirium, agitation, mortality, bradycardia and hypotension) was conducted to assess the risk of publication bias . The I 2 test was used to assess the heterogeneity of studies; values of less than 40%, 40–60% and more than 60% were used to determine low, moderate and substantial heterogeneity, respectively .…”

Section: Methodsmentioning

confidence: 99%

The effect of dexmedetomidine on delirium and agitation in patients in intensive care: systematic review and meta‐analysis with trial sequential analysis

Shubash

Chong

2018

Anaesthesia

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Delirium is common in intensive care patients. Dexmedetomidine is increasingly used for sedation in this setting, but its effect on delirium remains unclear. The primary aim of this review was to examine whether dexmedetomidine reduces the incidence of delirium and agitation in intensive care patients. We sought randomised clinical trials in MEDLINE, EMBASE, PubMed and CENTRAL from their inception until June 2018. Observational studies, case reports, case series and non-systematic reviews were excluded. Twenty-five trials including 3240 patients were eligible for inclusion in the data synthesis. In the patients who received dexmedetomidine (eight trials, 1425 patients), delirium was reduced, odds ratio (95%CI) 0.36 (0.26-0.51), p < 0.001 and high quality of evidence. The use of dexmedetomidine was associated with a reduced incidence of agitation, OR (95%CI) 0.34 (0.20-0.59), p < 0.001, moderate quality of evidence. Patients who were randomly assigned to dexmedetomidine had a significantly higher incidence of bradycardia, OR (95%CI) 2.18 (1.46-3.24), p < 0.001, moderate quality of evidence; and hypotension, OR (95%CI) 1.89 (1.48-2.41), p < 0.001, high quality of evidence. We found no evidence of an effect on mortality, OR (95%CI) 0.86 (0.66-1.10), p = 0.23, moderate quality of evidence. The trial sequential analyses for the incidence of delirium, bradycardia and hypotension was conclusive but not for the incidence of agitation and mortality. In summary, this meta-analysis suggests that dexmedetomidine reduces the incidence of delirium and agitation in intensive care patients. The general quality of evidence ranged from moderate to high.

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“…We have not identified any systematic reviews investigating treatment of fluid overload in general intensive care patients, but we have found systematic reviews investigating furosemide in patients with acute decompensated heart failure, 22 co‐administration of furosemide and albumin in patients with hypoalbuminemia 23 and furosemide's impact on mortality and requirement for renal replacement therapy in acute kidney injury 24 . Those reviews included only few randomised clinical trials among ICU patients.…”

Section: Why It Is Important To Do This Reviewmentioning

confidence: 99%

Loop diuretics in adult intensive care patients with fluid overload: A protocol for a systematic review of randomised clinical trials with meta‐analysis and Trial Sequential Analysis

Wichmann

Barbateskovic

Lindschou

et al. 2020

Acta Anaesthesiol Scand

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Background In the intensive care unit, fluid overload is frequent and a risk factor for organ dysfunction and increased mortality. Primarily, lung and kidney functions may be impaired by fluid overload resulting in acute respiratory failure and acute kidney injury. No clinical guidelines exist for treatment of fluid overload in intensive care patients. Loop diuretics, most often furosemide, appear to be the most frequently used pharmacological intervention. The aim of this protocol is to describe the methods of a systematic review assessing the evidence of treatment with loop diuretics in adult intensive care patients with fluid overload. Methods We will conduct a systematic review with meta‐analysis and report it according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) Statements, use the recommendations of the Cochrane Handbook and assess the quality of the evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. We will include randomised clinical trials identified through searches of major international databases and trial registers. Two authors will independently screen and select trials for inclusion, extract data and assess the methodological quality using the Cochrane risk of bias tool. Extracted data will be analysed using Review Manager and Trial Sequential Analysis. The protocol is registered at PROSPERO. Discussion We aim to provide reliable evidence on the use of loop diuretics in adult intensive care patients with fluid overload to guide clinicians, decision makers and trialists on clinical practice.

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Continuous infusion vs. intermittent bolus injection of furosemide in acute decompensated heart failure: systematic review and meta‐analysis of randomised controlled trials

Cited by 52 publications

References 30 publications

Effect of diuretic infusion clinic in preventing hospitalization for patients with decompensating heart failure

Effect of diuretic infusion clinic in preventing hospitalization for patients with decompensating heart failure

The effect of dexmedetomidine on delirium and agitation in patients in intensive care: systematic review and meta‐analysis with trial sequential analysis

Loop diuretics in adult intensive care patients with fluid overload: A protocol for a systematic review of randomised clinical trials with meta‐analysis and Trial Sequential Analysis

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