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

Abstract

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 2011. © 2011 Society of Hospital Medicine.

A Diuretic Protocol Increases Volume Removal and Reduces Readmissions Among Hospitalized Patients With Acute Decompensated Heart Failure

“…Published studies have focused on comparing diuretic dose delivery mechanisms such as continuous infusions and bolus dosing. 7,8 Although the method of dose delivery is an important issue in the management of ADHF, a number of critical factors must be considered to adequately remove volume. First, an appropriate dose of loop diuretic must be given to ensure sufficient and controlled diuresis.…”

Appropriate diuretic dosing: Closed loop communication

“…Currently, clinicians have no clear evidence‐based strategies for using diuretics to safely reduce congestion in patients with ADHF. As shown by Amer et al,2 continuous furosemide infusion may provide more effective weight and volume loss than bolus injections. More rigorous studies comparing effectively dosed diuretics regimens are needed.…”

“…In this issue of the Journal of Hospital Medicine , Amer et al2 present a meta‐analysis of randomized controlled trials comparing continuous infusion to bolus doses of furosemide in hospitalized patients with ADHF. The study demonstrates that continuous infusion is superior to bolus in terms of weight loss and urine output over 24 hours.…”

Diuretic therapy in acute decompensated heart failure – Bolus or continuous?

“…Urinary Sodium excretion and duration of hospital stay did not differ between the two groups. 13 In this issue of the Indian heart journal, Shah et al have presented their elegantly conducted study of comparison of i n d i a n h e a r t j o u r n a l 6 6 ( 2 0 1 4 ) 3 1 7 e3 1 9…”