At. Yetman et al., ACUTE HEMODYNAMIC AND NEUROHORMONAL EFFECTS OF FUROSEMIDE IN CRITICALLY ILL PEDIATRIC-PATIENTS, Critical care medicine, 24(3), 1996, pp. 398-402
Objectives: To study the acute hemodynamic effects of furosemide in cr
itically ill pediatric patients, the temporal relationship between hem
odynamic changes and changes in neuroendocrine axis, and the temporal
relationship between hemodynamic changes and urine output. Design: Pro
spective study. Setting: Pediatric intensive care unit in a tertiary c
are university center. Patients: Fourteen critically ill pediatric pat
ients who clinically required diuretic therapy. Interventions: Before
and after furosemide administration, hemodynamic and neurohormonal mea
surements were taken. Measurements and Main Results: Hemodynamic and n
eurohormonal responses to acute diuretic therapy were measured in 14 p
ediatric patients treated with furosemide (1 mg/kg/dose). Cardiac inde
x deteriorated by 10 mins after drug administration (-9.4 +/- 3.9%, p
< .05) and was associated with an increase in systemic vascular resist
ance (17.1 +/- 4.8%, p < .05), There was a subsequent increase in card
iac index (20 +/- 4.9%, p < .05) at 30 mins, with a decrease in system
ic vascular resistance (-11.5 +/- 5.2%, p < .05), These hemodynamic ch
anges were associated with marked increases in renin and norepinephrin
e concentrations and an increase in urinary prostaglandin release. The
hemodynamic and neurohormonal effects had their onset before maximum
diuresis. Conclusion: Intravenous furosemide administration in acutely
ill pediatric patients results in an acute but transient deterioratio
n in cardiac function that appears to parallel the neuroendocrine chan
ges rather than the acute diuresis.