Key result
Continuous IV furosemide resolves infant HF symptoms ~14 hours faster than repeated boluses.
Why the study?
Previous pediatric data on continuous furosemide infusion was limited to post-cardiac surgery, prompting an evaluation of its efficacy and safety versus repeated injections for ADHF in infants with left to right shunt.
Does furosemide continuous intravenous infusion reduce the hours required for resolution of failure symptoms in infants with acute decompensated heart failure secondary to left to right shunt compared to repeated intravenous boluses?
RCT (n=54)
Open-label
Closed sealed opaque envelopes
No
Does furosemide continuous intravenous infusion reduce the hours required for resolution of failure symptoms in infants with acute decompensated heart failure secondary to left to right shunt compared to repeated intravenous boluses?
Absolute Event Rate: 42.1% vs 56%
p-value: p=0.001
Continuous intravenous infusion of furosemide safely accelerates the resolution of fluid overload symptoms with less hemodynamic instability compared to repeated bolus injections in infants with acute decompensated heart failure.
Continuous furosemide infusion may speed symptom relief with lower doses in infant ADHF but raises creatinine; leaves open optimal strategy and safety in larger trials.
Background Furosemide is the foremost drug used in the management of acute decompensated heart failure (ADHF). By tradition, it was administered as repeated intravenous boluses but fluctuations in intravascular volume and blood pressure were noticed in addition to the possibility of toxicity. Hence, continuous intravenous infusion was thought of as an alternative route of administration. In searching the literature, all previously published data concerning the pediatric age group was for infants and children following cardiac surgery. This study aims to compare the efficacy and safety of furosemide repeated injection versus continuous infusion during the management of ADHF in infants with left to right shunt. Methods A prospective parallel-design randomized study was conducted on 54 infants with ADHF, Ross class IV, secondary to left to right shunt. Twenty-seven infants received repeated injections of furosemide and 27 infants had furosemide continuous infusion. Patients were followed clinically for weight, urine output, hours required for resolution of failure symptoms, serum creatinine, sodium and potassium, and length of hospital stay. Results Non-significant differences were observed between both groups regarding preadmission oral furosemide dose and serum creatinine level. A lower daily dose of furosemide was observed in the continuous infusion arm (3.5 ± 0.6 vs 4.7 ± 1.0, p = 0.001) with less fluctuation in urine output and significantly fewer hours required for resolution of failure symptoms (42.1 ± 9 vs 56 ± 18.5, p = 0.001). At the end of furosemide infusion, serum creatinine was significantly higher in the continuous infusion group (0.39 ± 0.06 vs 0.34 ± 0.1, p = 0.030). However, before hospital discharge, non-significant differences were noticed (0.32 ± 0.05 vs 0.33 ± 0.06, p = 0.584). Non-significant differences between both groups regarding serum sodium and potassium levels at the end of furosemide injection were detected ( p = 0.289, 0.890, respectively). Conclusion Continuous infusion of furosemide can be safely administered to infants with ADHF, Ross class IV, secondary to left to right shunt with clinical gradual alleviation of fluid overload symptoms and less hemodynamic instability than repeated injections. Trial registration The study was approved by the Mansoura Faculty of Medicine institutional research board (MS/16.02.41) on August 3rd, 2016.
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Zarzor et al. (2023) conducted an RCT in Acute decompensated heart failure (Ross class IV) secondary to left to right shunt (n=54). Furosemide continuous intravenous infusion vs. Furosemide repeated intravenous boluses (1-2 mg/kg/dose every 8 h) was evaluated on Hours required for the resolution of failure symptoms (p=0.001). Continuous intravenous infusion of furosemide significantly reduced the time required for resolution of heart failure symptoms compared to repeated injections (42.1 vs 56.0 hours, p=0.001) in infants.
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