A Study on Continuous Infusion versus Intermittent bolus dosing of Furosemide in Hospitalized Heart failure patients

Introduction: Intravenous loop diuretics is one of the cornerstone therapy of heart failure patients presenting with congestion, however the optimal dosage and administration strategies remain poorly defined. We intended to evaluate the differences between the two administration routes based on the efficacy and the renal functions. Methods: Sixty patients with heart failure admitted in the critical care medicine were initially enrolled in the study. Four patients were excluded due to eGFR<15ml/min. The remaining 28 patients in each group (Group I: continuous furosemide infusion (cIV) and Group II: intermittent furosemide bolus injections (iIV) i.e., three equal intermittent daily doses) were administered with Inj. Furosemide (120mg/day). All patients were daily evaluated for NYHA class, urine output, serum electrolytes, BNP, and renal parameters. Results: The efficacy of the either group of intravenous administration were evaluated using the following end points such as cumulative urine output (2,505±796 vs 2140±468 ml/day, p < 0.04), serum creatinine levels, B.U.N levels, G.F.R and BNP levels. 56 patients were studied with 28 in each group. The c1V group showed an increase in urine output and a more significant decrease in the BNP levels when compared to the bolus. We observed a significant difference in GFR (p<0.05), creatinine (p<0.01) and B.U.N (p<0.05) from baseline to the end of treatment in both the groups. Conclusion: The administration of intermittent furosemide bolus injection (iIV) is better than continuous furosemide infusion (c1V). Theoretically, cIV appeared to provide more efficient gradual diuresis with less neurohormonal activation, however it was also associated with increased rate of worsening renal function during hospitalisation.