Lisa Owens, MD; Akella Chendrasekhar, MD(*); Christopher Reising, MD; Donald W Moorman, MD and Gregory A Timberlake, MD. Surgery, Iowa Methodist Medical Center, Des Moines, IA.
PURPOSE: To assess the utility of continuous dose furosemide in critically Ill patients with Acute Respiratory Distress Syndrome(ARDS)
METHODS: We performed a prospective randomized study on patients with severe ARDS (Murray lung injury score, LIS [is greater than] 2.5). Demographic data(age, gender, APACHE-2 score at study entry, & initial LIS) were obtained on all patients. Patients were then randomized to receive either continuous dose furosemide (0.2 mg/kg/hour) for 48 hours along with conventional supportive therapy or supportive therapy alone. All patients were monitored for hemodynamic data. Outcome data (change in LIS at 48 hours, change in PaO2/FIO2 ratio at 48 hours, Organ dysfunction during hospitalization and survival to hospital discharge)were collected on all patients.
RESULTS: Seven women and nine men were prospectively enrolled. The average age was 45 years(Range:19-72). Demographic data between the study group and control group were comparable. The cardiac filling volumes and pressures were maintained within 10 % of starting values throughout the study. There was noted to be a significant difference in urine output between the 2 groups, without any difference in fluid intake. The outcome data is listed in table 1. Organ dysfunction, specifically the incidence of oliguric renal failure was significantly greater in the control group and directly contributed to the increased mortality.
CONCLUSION: The use of continuous dose furosemide resulted in short term improvement in LIS and PaO2/FiO2 ratio. The increased diuresis seen in the study group may be associated with the decreased incidence of oliguric renal failure. The difference in hospital mortality does not seem to be related directly to the short term improvement in pulmonary function.
CLINICAL IMPLICATIONS: Continuous dose furosemide improves short term outcomes and seems to reduce the incidence of oliguric renal failure and thereby improves survival to hospital discharge.
GRANT SUPPORT: Iowa Health System
COPYRIGHT 2000 American College of Chest Physicians
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