Key result
Continuous infusion of furosemide was associated with a similar amount of administered drug compared to bolus injection (WMD -1.71 mg/kg/day, p=0.34) to achieve desired urinary output in pediatric patients after cardiac surgery.
Why the study?
Does continuous infusion of furosemide improve urinary output or reduce complications compared to bolus injection in pediatric patients after cardiac surgery?
Meta-Analysis (n=92)
Open-label
Randomized
Does continuous infusion of furosemide improve urinary output or reduce complications compared to bolus injection in pediatric patients after cardiac surgery?
Mean Difference: -1.71 (95% CI -5.2–1.78)
Absolute Event Rate: 2.1% vs 3.1%
p-value: p=0.34
Existing data are insufficient to confidently assess whether continuous infusion or bolus injection of furosemide is superior in pediatric patients after cardiac surgery, though both methods achieve desired urinary output.
Continuous infusion and bolus furosemide require similar dosing for target diuresis after pediatric cardiac surgery; leaves open optimal regimen for outcomes or complications.
Introduction. Acute renal failure and fluid retention are common problems in pediatric patients after cardiac surgery. Furosemide, a loop diuretic drug, is frequently administered to increase urinary output. The aim of the present study was to compare efficacy and complications of continuous infusion of furosemide vs bolus injection among pediatric patients after cardiac surgery.Methods. A systematic review and meta-analysis was performed in compliance with The Cochrane Collaboration and the Quality of Reporting of Meta-Analysis (QUORUM) guidelines. The following inclusion criteria were employed for potentially relevant studies: a) random treatment allocation, b) comparison of furosemide bolus vs continuous infusion, c) surgical or intensive care pediatric patients. Non-parallel design randomized trials (e.g. cross-over), duplicate publications and non-human experimental studies were excluded.Results. Up to August 2008, only three studies were found, with 92 patients randomized (50 to continuous infusion and 42 to bolus treatment). Overall analysis showed that continuous infusion and bolus administration were equally effective in achieving the predefined urinary output, and were associated with a similar amount of administered furosemide (WMD=-1.71 mg/kg/day [-5.20; +1.78], p for effect=0.34, p for heterogeneity<0.001, I2=99.0). However, in the continuous infu-sion group, patients had a significantly reduced urinary output (WMD=-0.48 ml/kg/day [-0.88; -0.08], p for effect=0.02, p for heterogeneity <0.70, I2=0%).Conclusions. Existing data comparing furosemide bolus injection with a continuous infusion are insufficient to confidently assess the best way to administer furosemide to pediatric patients after cardiac surgery. Larger studies are needed before any recommendations can be made.
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Zangrillo et al. (2012) conducted a meta-analysis in Fluid retention and acute renal failure risk after pediatric cardiac surgery (n=92). Continuous infusion of furosemide vs. Bolus injection of furosemide was evaluated on Amount of administered furosemide to achieve predefined urinary output (WMD -1.71 mg/kg/day, 95% CI -5.20 to 1.78, p=0.34). Continuous infusion of furosemide was associated with a similar amount of administered drug compared to bolus injection (WMD -1.71 mg/kg/day, p=0.34) to achieve desired urinary output in pediatric patients after cardiac surgery.
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