Heart failure: iv furosemide produced greater diuresis and natriuresis than bolus.

Clinical bottom line (level 1b)

  1. Patients with heart failure on continuous iv furosemide produced more urine (600 ml) and urinary sodium (60 mmol) than those on bolus infusions.
Dormans et al: Journal of the American College of Cardiology 1996; 28: 376-382
Expires July 2003

The study

Unblinded concealed randomised cross-over trial with intention-to-treat
Setting: university hospital, Holland

20 patients (aged range 51 to 89; mean 71, 65% male) New York Heart Association class III or IV congestive heart failure on high dose oral furosemide at baseline. Heart failure was compensated in 45% and decompensated in 55% (clinical oedema). Mean creatinine clearance was 45 mL/min.
Control Group: (n = 20, 20 analysed): each patient's usual daily oral furosemide dose given as an iv bolus over five minutes (mean dose 690 mg furosemide)
Experimental Group: (n = 20, 20 analysed): each patient's usual daily oral furosemide dose given as follows:20% as bolus over first five minutes, followed by 10% of total dose per hour for next 8 hours (mean dose 690 mg)
Patients had a one-day washout between treatments in this cross-over study.
100% followed for 2 days

The evidence

Outcome Control Group
(SD)		 Experimental Group
(SD)		 Mean Difference
(95% CI)
urine output over 24 hours (mL) 2,260
(150) 		2,860
(240) 		600
(560 to 640)
urinary sodium over 24 hours (mmol/L) 150
(20) 		210
(40) 		60
(50 to 70)

Comments

  1. This is a short-term study in patients with congestive heart failure and the differences in efficacy were only modest.
  2. Study was too small to show any effect on side effects (eg. ototoxicity). Five patients on bolus infusion had transient dizziness and deafness.

Citation

  1. Dormans TPJ, et al: Diuretic efficacy of high dose furosemide in severe heart failure: bolus injection versus continuous infusion. Journal of the American College of Cardiology 1996; 28: 376-382
Contributor: Catherine Clase and Chris Ball, July 2000
Reviewer:

Clinical Question.
Patient heart failure
Intervention or Exposure continuous furosemide
Comparison bolus furosemide
Outcome urine production