Continuous frusemide infusion versus intermittent bolus therapy in paediatric intensive care: A single centre
Nutnicha Preeprem1,2, Emily See3,4,5, Siva P Namachivayam5,6,7,8
1Pediatric Intensive Care Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Insights
Continuous infusion (CI) frusemide in critically ill children is more common in those with congenital heart disease (CHD) and higher acute kidney injury (AKI) severity. CI is initiated later and at higher doses than intermittent bolus (IB) therapy.
Area of Science:
- Pediatric Critical Care Medicine
- Pharmacology
- Nephrology
Background:
- Frusemide is a vital diuretic for critically ill children, administered via continuous infusion (CI) or intermittent bolus (IB).
- Understanding frusemide use patterns and associated factors is crucial for optimizing pediatric critical care.
- Acute kidney injury (AKI) is a significant concern in this patient population.
Purpose of the Study:
- To characterize children receiving intravenous frusemide in a pediatric intensive care unit (PICU).
- To describe patterns of CI versus IB frusemide administration.
- To investigate factors associated with initiating CI frusemide, including AKI incidence.
Main Methods:
- Retrospective observational study of children admitted to the PICU between 2017 and 2022.
- Analysis of intravenous frusemide administration (CI vs. IB), focusing on patient characteristics, timing, dosage, and AKI.
- Multivariable logistic regression was used to identify factors associated with CI initiation.
Main Results:
- 1387 of 9394 PICU admissions received IV frusemide; 16% received CI.
- Children receiving CI were younger, had higher PIM-3 scores, more congenital heart disease (CHD), and higher AKI incidence/severity at initiation compared to IB.
- CI was initiated later (46 vs. 19 hours) and at higher doses (4.3 vs. 1.5 mg/kg/day) than IB; CHD was associated with CI initiation (aOR 1.67).
Conclusions:
- Intravenous frusemide CI is more prevalent in PICU children with CHD, initiated later, and at higher doses compared to IB.
- Patients receiving CI frusemide exhibit a greater incidence and severity of AKI at therapy initiation.
- Congenital heart disease is a significant factor associated with the use of continuous infusion frusemide in critically ill children.
Objective:
Frusemide is a common diuretic administered to critically ill children intravenously, by either continuous infusion (CI) or intermittent bolus (IB). We aim to describe the characteristics of children who receive intravenous frusemide, patterns of use, and incidence of acute kidney injury (AKI), and to investigate factors associated with commencing CI.
Design:
Retrospective observational study.
Setting:
Paediatric intensive care unit (PICU), the Royal Children's Hospital Melbourne.
Participants:
Children who received intravenous frusemide during PICU admission lasting ≥24 h between 2017 and 2022.
Main Outcome Measures:
The primary outcome was the daily dose of frusemide. Secondary outcomes included timing of therapy from PICU admission, fluid balance at frusemide initiation, additional diuretic therapy, and the incidence of AKI at admission and frusemide initiation. Children who received CI were compared with those who received IB only using multivariable logistic regression analyses.
Results:
Nine thousand three ninety-four children were admitted during the study period. A total of 1387 children (15 %) received intravenous frusemide, including 220 children (16 %) by CI. The CI group were younger (132 vs 202 days, p = 0.01), had higher PIM-3 scores (2.2 vs 1.5, p-value <0.001), more congenital heart disease (CHD) (72.3 % vs 60.6 %, p <0.01), and higher incidence and severity of AKI at frusemide initiation than the IB group (65.7 % vs 40.1 %, p-value <0.001). CI were commenced later than IB (46 vs 19 h into admission, p <0.001) and at higher doses (4.3 vs 1.5 mg/kg/day, p-value <0.001). In multivariable analyses, CHD (aOR 1.67, 95 % CI 1.16-2.40, p <0.01) was associated with CI.
Conclusion:
Frusemide infusions are administered more commonly to children with CHD, later in PICU admission, and at higher daily doses compared to IB. Children who receive CI have a higher incidence and severity of AKI at initiation.
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