Continuous infusion versus bolus injection of furosemide in critically ill patients. A systematic review and meta-analysis

Introduction. Fluid overload and a positive fluid balance are common in the intensive care unit (ICU). Furosemide is frequently
administered to increase urine output. A bolus injection is the traditional mode of administration, but many concerns have been
raised about possible intravascular volume fluctuations, toxicity and enhanced tolerance. Furosemide related adverse effects
can be enhanced in critically ill patients. Continuous infusion should allow better hemodynamic stability, less side effects and
an easier achievement of the desired diuretic effect. We performed a systematic review and meta-analysis to compare the
effects and complications of continuous furosemide infusion with those of bolus injections in critically ill patients in the ICU.
Methods. Studies were searched in PubMed (updated January 2009). Backward snowballing of included papers was performed.
International experts were contacted for further studies.
The inclusion criteria were: random allocation to treatment, comparison of furosemide bolus vs continuous infusion, performed
in surgical or intensive care patients. The exclusion criteria were: non-parallel design randomized trials, duplicate
publications, non-human experimental studies, no outcome data.
Results. Four eligible randomized clinical trials were identified, including 129 patients (64 to continuous infusion and 65 to
bolus treatment). Continuous perfusion was not associated with a significant reduction in risk of mortality as compared to
bolus injection
Conclusions. Furosemide in continuous perfusion was not associated with a significant reduction in risk of hospital mortality
as compared to bolus administration in critically ill patients in ICU, but existing data are insufficient to confidently assess
the best way to administer furosemide . Applying a protocol to drive furosemide therapy could be more relevant than the
chosen mode of administration.