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Published on: September 24, 2020
A Randomized Controlled Trial of a Single Dose Furosemide to Improve Respiratory Distress in Moderate to Severe
Kristy Williamson1, Gabriel Bredin2, Jahn Avarello1
1Department of Pediatric Emergency Medicine, Cohen Children's Medical Center of New York, New Hyde Park, New York.
Insights
Early diuretic use in infants with bronchiolitis did not improve respiratory distress or reduce hospital stay. This randomized trial found no significant benefit of furosemide over placebo in managing this common infant respiratory illness.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Clinical Trials
Background:
- Bronchiolitis is a frequent lower respiratory tract infection in infants.
- Diuretics have been historically used for severe bronchiolitis, but early administration in emergency settings remains understudied.
Purpose of the Study:
- To assess if a single early diuretic dose improves respiratory distress in infants with moderate to severe bronchiolitis.
- To evaluate the impact of early diuretic use on noninvasive ventilation requirements and hospital length of stay.
Main Methods:
- A double-blind, randomized controlled trial involving 46 infants diagnosed with clinical bronchiolitis.
- Participants received either furosemide or a placebo, with respiratory rate and oxygen saturation monitored post-intervention.
- Statistical analysis using exact logistic regression examined the outcomes.
Main Results:
- No significant difference in respiratory rate improvement (≥ 25% decrease) was observed between the furosemide and placebo groups at 2 and 4 hours.
- Oxygen saturation, intensive care unit admission rates, and hospital length of stay did not differ between the groups.
Conclusions:
- A single early dose of furosemide did not demonstrate a benefit in improving respiratory distress or other clinical outcomes in infants with bronchiolitis.
- The study suggests that early diuretic administration is not effective for managing moderate to severe bronchiolitis in the emergency department.
Background:
Bronchiolitis is one of the most common disorders of the lower respiratory tract in infants. While historically diuretics have been used in severe bronchiolitis, no studies have looked directly at their early use in children in the emergency department.
Objective:
The primary objective of this study was to determine whether a single early dose of a diuretic in infants with moderate to severe bronchiolitis would improve respiratory distress. Secondary objectives examined whether it reduced the use of noninvasive ventilation and hospital length of stay.
Methods:
Patients diagnosed with clinical bronchiolitis were enrolled at a tertiary care, academic children's hospital over a 3-year period. This was a double-blind, randomized controlled trial in which subjects were randomly assigned to either furosemide or placebo. Respiratory rate and oxygen saturation at the time of medication delivery and at 2 and 4 h post-intervention were recorded, as well as other data. Exact logistic regression was used to examine associations.
Results:
There were 46 subjects enrolled and randomized. There was no difference in respiratory rates, measured as a decrease of ≥ 25%, at both 2 and 4 h after intervention between furosemide and placebo groups (odds ratios 1.13 and 1.13, respectively). There was also no difference in oxygen saturation, intensive care unit admission rate, or hospital length of stay between groups.
Conclusions:
While theoretically a single dose of a diuretic to reduce lung fluid would improve respiratory distress in children with bronchiolitis, our randomized controlled medication trial showed no difference in outcomes. ClinicalTrials.gov ID: NCT02469597.
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