RT5-LTC Article and summary

Continuous versus bolus intermittent loop diuretic infusion in acutely decompensated heart failure: a prospective randomized trial

Summary of articles

  • It is prospective, randomized, open label study
  • Purpose of this study: evaluate the effects of continuous infusion of Lasix in comparison with a twice daily regimen at similar doses in patients with diagnosed with acute decompensated CHF
  • Method: 82 patients who dx with acute decompensated CHF
  • Continuous Lasix group: 43 patients with starting dose 80+-20mg/day
  • Intermittent/bolus Lasix group: 39 patients with starting dose 80+-20mg/day
  • Outcomes

Both groups are followed

Primary outcomes: changes in creatinine, estimated glomerular filtration rate, and reduction in BNP

Secondary outcomes: rate of acute kidney injury, hospital stay, change in body weight, readmission rate

Results:

Primary outcomes results: the change in serum creatinine is higher and eGFR is lower in the continuous infusion group. But, the reduction in BNP is significantly greater with the continuous infusion group.

Secondary outcome results: the incidence of AKI is similar, the hospital stay is longer in the continuous infusion group, no significant difference of weight loss, readmission is higher in continuous infusion group

 

  • Conclusion

Continuous infusions of Lasix in patients with ADHF appear to provide more     benefits, together with better reduction of BNP levels in comparison with bolus therapy          during the in-hospital period. But continuous infusion also has greater reductions in     eGFR and higher rates of readmission. More studies with larger sample                size/multicenter should be done

  • Relating to my patient

My patient, Mrs. W is a 79 years old female who are symptomatic with weight gain, edema, SOB, and coughing. She is diagnosed with decompensated CHF. In the hospital, she was given 2 IV push in ED and then continuous IV after admission. In the clinical practice, continuous infusion is favored over bolus.

Continuous versus bolus intermittent loop diuretic infusion in acutely decompensated heart failure a prospective randomized trial.

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