Author(s):
Jaya Shree D, Christy John Daniel, Christan Marsh, Jacintha Sharon Daniel, Lavanya S
Email(s):
lavanya.s16195@paruluniversity.ac.in
DOI:
0.52711/0974-360X.2021.00496 
Address:
Jaya Shree D1, Christy John Daniel1, Christan Marsh1, Jacintha Sharon Daniel1, Lavanya S2
1Department of Pharmacy Practice, C.L. Baid Metha College of Pharmacy, Thoraipakkam, Chennai, Tamil Nadu.
2Department of Pharmacy Practice, Parul Institute of Pharmacy, Parul University, Limda, Vadodara, Gujarat.
*Corresponding Author
Published In:
Volume - 14,
Issue - 5,
Year - 2021
ABSTRACT:
Introduction: Intravenous loop diuretics is one of the cornerstone therapy of heart failure patients presenting with congestion, however the optimal dosage and administration strategies remain poorly defined. We intended to evaluate the differences between the two administration routes based on the efficacy and the renal functions. Methods: Sixty patients with heart failure admitted in the critical care medicine were initially enrolled in the study. Four patients were excluded due to eGFR<15ml/min. The remaining 28 patients in each group (Group I: continuous furosemide infusion (cIV) and Group II: intermittent furosemide bolus injections (iIV) i.e., three equal intermittent daily doses) were administered with Inj. Furosemide (120mg/day). All patients were daily evaluated for NYHA class, urine output, serum electrolytes, BNP, and renal parameters. Results: The efficacy of the either group of intravenous administration were evaluated using the following end points such as cumulative urine output (2,505±796 vs 2140±468 ml/day, p < 0.04), serum creatinine levels, B.U.N levels, G.F.R and BNP levels. 56 patients were studied with 28 in each group. The c1V group showed an increase in urine output and a more significant decrease in the BNP levels when compared to the bolus. We observed a significant difference in GFR (p<0.05), creatinine (p<0.01) and B.U.N (p<0.05) from baseline to the end of treatment in both the groups. Conclusion: The administration of intermittent furosemide bolus injection (iIV) is better than continuous furosemide infusion (c1V). Theoretically, cIV appeared to provide more efficient gradual diuresis with less neurohormonal activation, however it was also associated with increased rate of worsening renal function during hospitalisation.
Cite this article:
Jaya Shree D, Christy John Daniel, Christan Marsh, Jacintha Sharon Daniel, Lavanya S. A Study on Continuous Infusion versus Intermittent bolus dosing of Furosemide in Hospitalized Heart failure patients. Research Journal of Pharmacy and Technology. 2021; 14(5):2814-8. doi: 0.52711/0974-360X.2021.00496
Cite(Electronic):
Jaya Shree D, Christy John Daniel, Christan Marsh, Jacintha Sharon Daniel, Lavanya S. A Study on Continuous Infusion versus Intermittent bolus dosing of Furosemide in Hospitalized Heart failure patients. Research Journal of Pharmacy and Technology. 2021; 14(5):2814-8. doi: 0.52711/0974-360X.2021.00496 Available on: https://www.rjptonline.org/AbstractView.aspx?PID=2021-14-5-80
REFERENCES:
1. Mosterd A, Hoes AW. Clinical epidemiology of heart failure. Heart. 2007 Sep 1; 93(9):1137-46.
2. Chaturvedi V, Parakh N, Seth S, Bhargava B, Ramakrishnan S, Roy A, Saxena A, Gupta N, Misra P, Rai SK, Anand K, Pandav CS, Sharma R, Prasad S. Heart failure in India: The INDUS (INDiaUkieri Study) study. J Pract Cardiovasc Sci 2016; 2: 28-35.
3. Lal S, Murtagw JG, Pollock AM, Fletcher E, Binnion PF. Acute hemodynamic effects of furosemide in patients with normal and raised left atrial pressures. Br Heart J. 1969; 31(11): 711-717.
4. Dikshit K, Vyden JK, Forrester JS, et al. Renal and extrarenal hemodynamic effects of furosemide in congestive heart failure after myocardial infarction. N Engl J Med.1973; 288(3):1087-1090.
5. Magrini F, Niarchos AP. Hemodynamic effects of massive peripheral edema. Am Heart J. 1983;105(5): 90-94.
6. Stampfer M, Epstein SE, Beiser DG, Braunwald E. Hemodynamic effects of diuresis at rest and during intense upright exercise in patients with impaired cardiac function. Circ. 1968; 37(14): 900-911.
7. Knight RK, Miall PA, Hawkins LA, Dacombe J, Edwards CR, Hamer J. Relation of plasma aldosterone concentration to diuretic treatment in patients with severe heart disease. Br Hear J. 1979; 42: 316–325.
8. Sarraf M, Masoumi A, Schrier RW. Cardiorenal syndrome in acute decompensated heart failure. Clin. J Amer Soc Nephr. 2009 Dec 1;4(12): 2013-26.
9. Francis GS, Benedict C, Johnstone DE, Kirlin PC, Nicklas J, Liang CS, et al. Comparison of neuroendocrine activation in patients with left ventricular dysfunction with and without congestive heart failure. A substudy of the Studies of Left Ventricular Dysfunction (SOLVD). Circulation. 1990; 82:1724–1729.
10. Greenberg A. Diuretic complications. Amer J med Sci. 2000 Jan 1;319(1): 10-24.
11. Hropot M, Fowler N, Karlmark B, Giebisch G. Tubular action of diuretics: distal effects on electrolyte transport and acidification. Kidney Int. 1985; 28: 477–489.
12. Gulbis BE, Spencer AP. Efficacy and safety of a furosemide continuous infusion following cardiac surgery. Annal. Pharm. 2006 Oct;40(10):1797-803.
13. Mojtahedzadeh M, Salehifar E, Vazin A, Mahidiani H, Najafi A, Tavakoli M, Nayebpour M, Abdollahi M. Comparison of hemodynamic and biochemical effects of furosemide by continuous infusion and intermittent bolus in critically ill patients. JIN. 2004 Jul 1;27(4): 255-61.
14. Felker GM, Lee KL, Bull DA, Redfield MM, Stevenson LW, Goldsmith SR, et al. Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med. 2011; 364: 797–805.
15. Butler J, Forman DE, Abraham WT, Gottlieb SS, Loh E, Massie BM, et al. Relationship between heart failure treatment and development of worsening renal function among hospitalized patients. Am Hear J. 2004; 147: 331–338.
16. Dos Reis D, Fraticelli L, Bassand A, Manzo-Silberman S, Peschanski N, Charpentier S, Elbaz M, Savary D, Bonnefoy-Cudraz E, Laribi S, Henry P. Impact of renal dysfunction on the management and outcome of acute heart failure: results from the French prospective, multicentre, DeFSSICA survey. BMJ open. 2019 Jan 1;9(1): bmjopen-2018.
17. Palazzuoli A, Pellegrini M, Franci B, Beltrami M, Ruocco G, Gonnelli S, Angelini GD, Nuti R. Short and long-term effects of continuous versus intermittent loop diuretics treatment in acute heart failure with renal dysfunction. IEM. 2015 Feb 1;10(1): 41-9.
18. Shah RA, Subban V, Lakshmanan A, Narayanan S, Udhayakumaran K, Pakshirajan B, Krishnamoorthy J, Latchumanadhas K, Janakiraman E, Mullasari AS. A prospective, randomized study to evaluate the efficacy of various diuretic strategies in acute decompensated heart failure. IHJ. 2014 May 1;66(3): 309-16.
19. Palazzuoli A, Pellegrini M, Ruocco G, Martini G, Franci B, Campagna MS, Gilleman M, Nuti R, McCullough PA, Ronco C. Continuous versus bolus intermittent loop diuretic infusion in acutely decompensated heart failure: a prospective randomized trial. Critical care. 2014 Jun;18(3): 134.
20. Cleland JG, Coletta A, Witte K. Practical applications of intravenous diuretic therapy in decompensated heart failure. Amer. J Med. 2006 Dec 1;119(12): 26-36.
21. Ng KT, Velayit A, Khoo DK, Ismail AM, Mansor M. Continuous infusion versus intermittent bolus injection of furosemide in critically Ill patients: a systematic review and meta-analysis. JCVA. 2018 Oct 1;32(5): 2303-10.