THE EFFECT OF FUROSEMIDE IN CRITICALLY ILL ADULT PATIENTS –  A NARRATIVE REVIEW

Cyndi Yulanda Putri; Agung Endro Nugroho; Widyati Widyati

doi:10.22146/farmaseutik.v20i3.88784

THE EFFECT OF FUROSEMIDE IN CRITICALLY ILL ADULT PATIENTS – A NARRATIVE REVIEW

https://doi.org/10.22146/farmaseutik.v20i3.88784

Cyndi Yulanda Putri^(1*), Agung Endro Nugroho⁽²⁾, Widyati Widyati⁽³⁾

(1) Faculty of Pharmacy Universitas Gadjah Mada
(2) Faculty of Pharmacy Universitas Gadjah Mada
(3) Universitas Pertahanan
(*) Corresponding Author

Abstract

Background: Fluid overload is the common condition in the critically ill patients. This associated with the increased fluid intake and inadequate elimination. The management of fluid overload is by fluid removal with diuretic. Furosemide is a loop diuretic that frequently used as the initial therapy. However, the utilization of furosemide in the critically ill reminds a polarizing subject. The purpose of this study is to investigate the impact of furosemide on patients who are critically ill.

Methods: The inclusion criteria included randomized controlled trials as well as observational cohort studies. The data sources utilized in this study were PubMed, Science Direct, ProQuest, and Cochrane.

Results: We included 13 articles, of which 9 articles about generally critically ill patients with or without acute kidney injury (AKI), 2 articles about heart failure, and 2 articles about post operative. The furosemide was effective in generally critically ill patients with or without AKI, it can decrease the fluid balance, weight change, and improves the urine output. Furosemide had no harmful effect on kidney function. However, patients without oliguria were not recommended to receive high dose of furosemide. Critically ill patients with heart failure who received continuous infusion of furosemide were more susceptible to increased diuresis and greater depression of thoracic fluid content (TFC). Furthermore, it might cause the decrease of renal function. When compared to furosemide, continuous veno-venous hemodiafiltration (CVVHDF) was more successful at removing excess fluid, reducing weight, relieving symptoms, and improving hemodynamic and cardiac performance. In post operative patients, furosemide might cause metabolic alkalosis. Urinary electrolyte excretion rates were promptly altered by the use of low dose furosemide.

Conclusion: Based on the patient's clinical data, furosemide use should be taken into consideration. In general, furosemide is effective to improve diuresis. Furosemide in the AKI condition with oliguria has beneficial effect. However, in heart failure condition, furosemide might affect renal function. In post operative, it might cause metabolic alkalosis. Further randomized controlled trial (RCT) is required.

Keywords

furosemide; critically ill; ICU; AKI

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References

Pfortmueller CA, Schefold JC. Hypertonic saline in critical illness - A systematic review. Journal of Critical Care. 2017;42:168-177. doi:10.1016/j.jcrc.2017.06.019

Emanuel R, Bryant N, Suzanne H, et al. Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock. The New England Journal of Medicine. Published online 2001.

Besen BAMP. Fluid and electrolyte overload in critically ill patients: An overview. WJCCM. 2015;4(2):116. doi:10.5492/wjccm.v4.i2.116

O’Connor ME, Prowle JR. Fluid Overload. Critical Care Clinics. 2015;31(4):803-821. doi:10.1016/j.ccc.2015.06.013

Sánchez M, Jiménez-Lendínez M, Cidoncha M, et al. Comparison of Fluid Compartments and Fluid Responsiveness in Septic and Non-Septic Patients. Anaesth Intensive Care. 2011;39(6):1022-1029. doi:10.1177/0310057X1103900607

El-Sharkawy AM, Sahota O, Maughan RJ, Lobo DN. The pathophysiology of fluid and electrolyte balance in the older adult surgical patient. Clinical Nutrition. 2014;33(1):6-13. doi:10.1016/j.clnu.2013.11.010

Veiga D, Luis C, Parente D, et al. Postoperative Delirium in Intensive Care Patients: Risk Factors and Outcome. Brazilian Journal of Anesthesiology. 2012;62(4):469-483. doi:10.1016/S0034-7094(12)70146-0

Marik PE. Iatrogenic salt water drowning and the hazards of a high central venous pressure. Ann Intensive Care. 2014;4(1):21. doi:10.1186/s13613-014-0021-0

Gieling RG, Ruijter JM, Maas AAW, et al. Hepatic response to right ventricular pressure overload. Gastroenterology. 2004;127(4):1210-1221. doi:10.1053/j.gastro.2004.07.057

Lobo DN. Fluid, electrolytes and nutrition: physiological and clinical aspects. Proc Nutr Soc. 2004;63(3):453-466. doi:10.1079/PNS2004376

Nisanevich V, Felsenstein I, Almogy G, Weissman C, Einav S, Matot I. Effect of Intraoperative Fluid Management on Outcome after Intraabdominal Surgery. Anesthesiology. 2005;103(1):25-32. doi:10.1097/00000542-200507000-00008

Brandstrup B, Tønnesen H, Beier-Holgersen R, et al. Effects of Intravenous Fluid Restriction on Postoperative Complications: Comparison of Two Perioperative Fluid Regimens. Ann Surg. 2003;238(5):641-648. doi:10.1097/01.sla.0000094387.50865.23

Rahbari NN, Zimmermann JB, Schmidt T, Koch M, Weigand MA, Weitz J. Meta-analysis of standard, restrictive and supplemental fluid administration in colorectal surgery. British Journal of Surgery. 2009;96(4):331-341. doi:10.1002/bjs.6552

Lobo DN, Dube MG, Neal KR, Allison SP, Rowlands BJ. Peri-operative fluid and electrolyte management: a survey of consultant surgeons in the UK. Ann R Coll Surg Engl. 2002;84(3):156-160.

Claure-Del Granado R, Mehta RL. Fluid overload in the ICU: evaluation and management. BMC Nephrol. 2016;17(1):109. doi:10.1186/s12882-016-0323-6

Badawy SSI, Fahmy A. Efficacy and cardiovascular tolerability of continuous veno-venous hemodiafiltration in acute decompensated heart failure: A randomized comparative study. Journal of Critical Care. 2012;27(1):106.e7-106.e13. doi:10.1016/j.jcrc.2011.05.013

Bagshaw SM, Gibney RTN, Kruger P, Hassan I, McAlister FA, Bellomo R. The effect of low-dose furosemide in critically ill patients with early acute kidney injury: A pilot randomized blinded controlled trial (the SPARK study). Journal of Critical Care. 2017;42:138-146. doi:10.1016/j.jcrc.2017.07.030

Berthelsen RE, Perner A, Jensen AK, et al. Forced fluid removal in intensive care patients with acute kidney injury: The randomised FFAKI feasibility trial. Acta Anaesthesiol Scand. 2018;62(7):936-944. doi:10.1111/aas.13124

Cinotti R, Lascarrou JB, Azais MA, et al. Diuretics decrease fluid balance in patients on invasive mechanical ventilation: the randomized-controlled single blind, IRIHS study. Crit Care. 2021;25(1):98. doi:10.1186/s13054-021-03509-5

Connor KA, Conn K, Kaufman DC, Haas CE. Acid–base effects of continuous infusion furosemide in clinically stable surgical ICU patients: an analysis based on the Stewart model. Clin Exp Nephrol. 2020;24(6):541-546. doi:10.1007/s10157-020-01867-y

Côté JM, Bouchard J, Murray PT, Beaubien-Souligny W. Diuretic strategies in patients with resistance to loop-diuretics in the intensive care unit: A retrospective study from the MIMIC-III database. Journal of Critical Care. 2021;65:282-291. doi:10.1016/j.jcrc.2021.06.009

Hamishehkar H, Fattahi V, Mesgari M. The Effect of Furosemide on the Level of Neutrophil Gelatinase-Associated Lipocalin in Critically Hospitalized Patients with Acute Kidney Injury. Indian Journal of Critical Care Medicine. 2017;21(7):442-447. doi:10.4103/ijccm.IJCCM_93_17

Lee SJ, Kim CW, Lee MK, Kim SH, Yong SJ, Lee WY. Effect of high-dose furosemide on the prognosis of critically ill patients. Journal of Critical Care. 2017;41:36-41. doi:10.1016/j.jcrc.2017.04.045

Li C, Ren Q, Li X, Han H, Xie K, Wang G. Association between furosemide administration and clinical outcomes in patients with sepsis-associated acute kidney injury receiving renal replacement therapy: a retrospective observational cohort study based on MIMIC-IV database. BMJ Open. 2023;13(7):e074046. doi:10.1136/bmjopen-2023-074046

Ostermann M, Alvarez G, Sharpe MD, Martin CM. Frusemide Administration in Critically Ill Patients by Continuous Compared to Bolus Therapy. Nephron Clin Pract. 2007;107(2):c70-c76. doi:10.1159/000108641

Ragab D, Taema KM, Farouk W, Saad M. Continuous infusion of furosemide versus intermittent boluses in acute decompensated heart failure: Effect on thoracic fluid content. The Egyptian Heart Journal. 2018;70(2):65-70. doi:10.1016/j.ehj.2017.12.005

Zazzeron L, Ottolina D, Scotti E, et al. Real-time urinary electrolyte monitoring after furosemide administration in surgical ICU patients with normal renal function. Ann Intensive Care. 2016;6(1):72. doi:10.1186/s13613-016-0168-y

Zhao G ju, Xu C, Ying J chao, et al. Association between furosemide administration and outcomes in critically ill patients with acute kidney injury. Crit Care. 2020;24(1):75. doi:10.1186/s13054-020-2798-6

Epstein FH, Prasad P. Effects of furosemide on medullary oxygenation in younger and older subjects. Kidney International. 2000;57(5):2080-2083. doi:10.1046/j.1523-1755.2000.00057.x

Peixoto AJ. Update in Nephrology and Hypertension: Evidence Published in 2015. Ann Intern Med. 2016;164(9):W42. doi:10.7326/M16-0243

Guffey JD, Haas CE, Crowley A, Connor KA, Kaufman DC. Hydrochloric Acid Infusion for the Treatment of Metabolic Alkalosis in Surgical Intensive Care Unit Patients. Ann Pharmacother. 2018;52(6):522-526. doi:10.1177/1060028018754389

Adrogué HJ, Madias NE. Management of Life-Threatening Acid–Base Disorders. New England Journal of Medicine. 1998;338(1):26-34. doi:10.1056/NEJM199801013380106

Webster NR, Kulkarni V. Metabolic Alkalosis in the Critically III. Critical Reviews in Clinical Laboratory Sciences. 1999;36(5):497-510. doi:10.1080/10408369991239286

DOI: https://doi.org/10.22146/farmaseutik.v20i3.88784