ACUTE HEMODYNAMIC AND NEUROHORMONAL EFFECTS OF FUROSEMIDE IN CRITICALLY ILL PEDIATRIC-PATIENTS

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.