Related Experiment Video

Updated: Dec 29, 2025

Bedside Ultrasound for Guiding Fluid Removal in Patients with Pulmonary Edema: The Reverse-FALLS Protocol
07:59

Bedside Ultrasound for Guiding Fluid Removal in Patients with Pulmonary Edema: The Reverse-FALLS Protocol

Published on: July 28, 2018

11.6K

Guidelines for Diuretic Utilization Reduce High Charge Medications

Janet M Simsic1, Kevin Dolan1, Julie Miller1

  • 1Heart Center, Nationwide Children's Hospital, Columbus, Ohio.

Pediatric Quality & Safety
|February 4, 2020
PubMed

Insights

Implementing standardized diuretic guidelines in the pediatric cardiothoracic intensive care unit (CTICU) significantly reduced high-cost medication use. This initiative successfully lowered diuretic charges without compromising patient care quality.

Area of Science:

  • Cardiology
  • Intensive Care Medicine
  • Pharmacology

Background:

  • Postsurgical cardiac patients commonly require diuretics.
  • Diuretic utilization in the pediatric cardiothoracic intensive care unit (CTICU) lacks standardization.
  • High-cost diuretics represent a significant charge in the CTICU.

Purpose of the Study:

  • To develop and implement standardized diuretic utilization guidelines in the CTICU.
  • To reduce the utilization of high-charge medications, specifically fenoldopam and intravenous (IV) chlorothiazide.
  • To maintain high-quality patient care during the process.

Main Methods:

  • Developed standardized diuretic utilization guidelines.
  • Implemented guidelines in the CTICU in April 2017.
  • Compared diuretic utilization and charges before and after implementation.

Main Results:

  • Fenoldopam starts decreased from 1.1 to 0.03 per 100 CTICU patient-days.
  • IV chlorothiazide doses reduced from 20 to 8 per 100 CTICU patient-days.
  • Mean diuretic charges dropped from $25,762 to $8,855 per 100 CTICU patient-days.

Conclusions:

  • Standardized diuretic guidelines were successfully implemented in the CTICU.
  • High-charge diuretic utilization was significantly reduced.
  • Care quality was not negatively impacted by the guideline implementation.

More Related Videos

A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings06:59

A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings

Published on: November 9, 2016

31.0K
Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform07:13

Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform

Published on: April 12, 2021

4.8K

Related Concept Videos

Heart Failure Drugs: Diuretics01:22

Heart Failure Drugs: Diuretics

Heart failure and kidney perfusion are interconnected in a complex way. Reduced renal perfusion and venous congestion are two significant factors that contribute to renal dysfunction in heart failure. The kidneys, primarily responsible for fluid balance in the body, are adversely affected due to compromised cardiac output and increased venous pressure. In response to reduced renal perfusion, the kidneys activate neurohumoral mechanisms to restore balance. However, these mechanisms can be...
746
Antihypertensive Drugs: Action of Diuretics01:16

Antihypertensive Drugs: Action of Diuretics

Diuretics are antihypertensive drugs used to treat hypertension resulting from sodium and water retention. Sodium, vital for fluid balance and nerve or muscle function, is regulated by the kidneys through millions of nephrons. Blood enters nephrons via afferent arterioles, which branch into capillaries called glomeruli. These filter blood plasma, allowing water and solutes, like sodium ions, to pass through capillary walls into Bowman's capsule. The filtrate then flows through various...
2.1K
Antihypertensive Drugs: Thiazide-Class Diuretics01:15

Antihypertensive Drugs: Thiazide-Class Diuretics

Thiazide diuretics are sulfonamide derivatives featuring a benzothiadiazine ring system in their molecular structure. Based on this structure, thiazide diuretics can be categorized into two groups: thiazide-type and thiazide-like diuretics. Thiazide-type diuretics, including hydrochlorothiazide and chlorothiazide, consist of a benzothiadiazine backbone with an attached sulfonamide group. Thiazide-like diuretics, such as chlorthalidone and indapamide, lack the thiazide ring but demonstrate...
1.5K
Heart Failure V: Medical Management01:30

Heart Failure V: Medical Management

Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
166
Drug Dosing in Renal Diseases: Dose Adjustments Based on Drug Clearance and Elimination Rate Constant01:25

Drug Dosing in Renal Diseases: Dose Adjustments Based on Drug Clearance and Elimination Rate Constant

In patients with renal disease, dosage adjustments are necessary to maintain therapeutic plasma drug concentrations and prevent toxicity or subtherapeutic exposure. Renal impairment alters drug pharmacokinetics, especially in conditions like uremia, where changes such as prolonged elimination half-life and altered apparent volume of distribution can significantly affect drug disposition. These changes require careful modification of the dosing regimen to achieve the desired clinical...
162
Antihypertensive Drugs: Potassium-Sparing Diuretics01:28

Antihypertensive Drugs: Potassium-Sparing Diuretics

Liddle syndrome is a genetically inherited form of hypertension characterized by the overactivity of epithelial sodium channels in the nephron, the functional unit of the kidney. This heightened activity leads to increased sodium reabsorption and excessive excretion of potassium. To counteract this, potassium-sparing diuretics such as amiloride are used. They function by blocking these sodium channels, thereby reducing the influx of sodium into the epithelial cells and minimizing the loss of...
2.1K