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 disadvanta ges associated with continuous infusion, and recommend monitoring para meters for the use of continuous infusion therapy. Current dosing guid elines for continuous infusion of loop diuretics have not been establi shed, but a summary of previously studied doses is provided. DATA SOUR CES: A literature search using MEDLINE, International Pharmaceutical A bstracts, 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 evalua ted in selected patient populations. All articles and clinical studies were considered for possible inclusion in the review. Information jud ged to be pertinent by the authors was selected for discussion. DATA S YNTHESIS: Comparative studies in the congestive heart failure (CHF), r enal-insufficient, and postcardiac surgery patient populations have sh own that loop diuretics administered by continuous infusion are more b eneficial than those given by intermittent bolus administration. In ad ult patients with CHF, furosemide 3-4 mg/h is recommended In adult and pediatric postcardiac surgery patients, furosemide dosages of 0.05 an d 0.1. mg/kg/h have produced diuresis. In patients with renal insuffic iency, bumetanide 0.912 mg/h has produced diuresis. Intravenous bolus doses were used in all studies reviewed except 1. These studies have i ndicated that continuous infusion of the loop diuretics yields diuresi s without increasing toxicity. CONCLUSIONS: The use of continuous infu sion loop diuretics is a therapeutic alternative for patients requirin g diuresis. This form of administration has provided more consistent u rine flow, fewer alterations in fluid balances, fewer urinary losses o f electrolytes as well as decreased dosage of the diuretic requirement s. The disadvantages have not been fully elucidated because of the lim ited evaluation of this administration method. Few studies have used t his method of administration; however, the few data available indicate that continuous infusion of loop diuretics is an efficacious alternat ive to conventional therapy.