THE ROLE OF CONTINUOUS-INFUSION LOOP DIURETICS

OBJECTIVE: To evaluate the role of continuous infusion loop diuretics in selected patient populations, discuss the advantages and disadvantages associated with continuous infusion, and recommend monitoring parameters for the use of continuous infusion therapy. Current dosing guidelines for continuous infusion of loop diuretics have not been established, but a summary of previously studied doses is provided. DATA SOURCES: A literature search using MEDLINE, International Pharmaceutical Abstracts, as well as additional references found in pertinent articles. STUDY SELECTION AND DATA EXTRACTION: Clinical studies concerning the use of loop diuretics administered by continuous infusion were evaluated in selected patient populations. All articles and clinical studies were considered for possible inclusion in the review. Information judged to be pertinent by the authors was selected for discussion. DATA SYNTHESIS: Comparative studies in the congestive heart failure (CHF), renal-insufficient, and postcardiac surgery patient populations have shown that loop diuretics administered by continuous infusion are more beneficial than those given by intermittent bolus administration. In adult patients with CHF, furosemide 3-4 mg/h is recommended In adult and pediatric postcardiac surgery patients, furosemide dosages of 0.05 and 0.1. mg/kg/h have produced diuresis. In patients with renal insufficiency, bumetanide 0.912 mg/h has produced diuresis. Intravenous bolus doses were used in all studies reviewed except 1. These studies have indicated that continuous infusion of the loop diuretics yields diuresis without increasing toxicity. CONCLUSIONS: The use of continuous infusion loop diuretics is a therapeutic alternative for patients requiring diuresis. This form of administration has provided more consistent urine flow, fewer alterations in fluid balances, fewer urinary losses of electrolytes as well as decreased dosage of the diuretic requirements. The disadvantages have not been fully elucidated because of the limited evaluation of this administration method. Few studies have used this method of administration; however, the few data available indicate that continuous infusion of loop diuretics is an efficacious alternative to conventional therapy.