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Use of Furosemide and Chlorothiazide Combination Continuous Infusion in Furosemide-Refractory Patients in the
Summer R Record1, Aaron A Harthan2, Sandeep Tripathi3
1Pharmacy Department, OSF Healthcare Saint Francis Medical Center/Children's Hospital of Illinois, 530 NE Glen Oak AVE, Peoria, IL, 61637, USA. summer.record@osfhealthcare.org.
Insights
Furosemide and chlorothiazide combination continuous infusion (FCCCI) effectively increased urine output and achieved negative fluid balance in pediatric ICU patients. This combination therapy is a viable option for aggressive diuresis, especially in patients with limited access.
Area of Science:
- Pediatric Intensive Care
- Pharmacology
- Nephrology
Background:
- Diuresis management in pediatric intensive care units (ICUs) is critical for fluid balance.
- Furosemide is a common diuretic, but some patients exhibit refractory responses.
- Combination therapies may offer enhanced efficacy for fluid management in critically ill children.
Purpose of the Study:
- To evaluate the efficacy and safety of furosemide and chlorothiazide combination continuous infusion (FCCCI) in pediatric ICU patients.
- To assess FCCCI's impact on urine output, fluid balance, and renal function.
- To identify patient subgroups that respond favorably to FCCCI.
Main Methods:
- Retrospective cohort study of pediatric ICU patients (<18 years) receiving FCCCI.
- Patients served as their own controls, comparing baseline to FCCCI therapy.
- Data collected on demographics, ventilation status, dialysis, diuretic duration, and laboratory values.
Main Results:
- FCCCI significantly increased urine output by 52% (2.2 mL/kg/h) and achieved a net negative daily fluid balance (-301.9 mL/day).
- 78.9% of furosemide-refractory patients responded to FCCCI, with younger and cardiothoracic surgery patients showing higher responsiveness.
- FCCCI increased potassium supplementation needs and slightly elevated serum creatinine, decreasing estimated glomerular filtration rate.
Conclusions:
- FCCCI significantly improves diuresis and fluid balance in pediatric ICU patients.
- FCCCI represents a reasonable strategy for aggressive diuresis, particularly in resource-limited settings.
- Routine monitoring of serum potassium is essential during FCCCI therapy.
Objective:
Our objective was to describe the efficacy and safety of furosemide and chlorothiazide combination continuous infusion (FCCCI) in children in a pediatric intensive care unit (ICU), including postoperative cardiac patients.
Methods:
This was a retrospective cohort study in a pediatric ICU within a tertiary care teaching hospital. Children aged < 18 years admitted from 1 January 2010 to 31 December 2019 were included if they received a furosemide infusion for at least 6 h and then transitioned to FCCCI. Each patient acted as their own control.
Results:
A total of 203 patients (107 [53%] postoperative cardiac) met the study inclusion criteria. The study population was 55% male and 74% Caucasian, with a median age of 4.9 months. Of the total patients, 143 (70.4%) required mechanical ventilation and 39 (19.2%) required dialysis. The median duration of furosemide and FCCCI was 24.6 h (interquartile range [IQR] 12.4-54) and 41 h (IQR 15-162), respectively. Urine output increased by 52% with FCCCI (mean increase of 2.2 mL/kg/h [95% confidence interval {CI} 1.8-2.5]; p < 0.01). The change to FCCCI led to a net negative daily fluid balance (mean difference - 301.9 mL/day [95% CI - 390.9 to - 212.9]; p < 0.01). FCCCI resulted in a greater requirement for potassium bolus supplementation (mean increase of 12.8 boluses [95% CI 8.5-17.2]; p < 0.01) and a small but statistically significant increase in serum creatinine (mean difference 0.1 mg/dL [95% CI 0.06-0.14]; p < 0.01) with a resultant decrease in estimated glomerular filtration rate (mean difference - 13.5 [95% CI 9.7-17.4]; p < 0.01). Of the furosemide-refractory patients, 78.9% were responsive to FCCCI. Younger patients and patients who underwent cardiothoracic surgery were more likely to be responsive. Nonresponders to FCCCI had slightly higher mortality (21 vs. 6.6%, p = 0.05).
Conclusions:
FCCCI resulted in a significant improvement in diuresis with achievement of negative fluid balance in pediatric ICU patients. FCCCI is a reasonable approach to aggressive diuresis in the pediatric patient, particularly in patients with limited access. Serum potassium should be routinely monitored during such therapy.
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