Efficacy of Continuous Infusions of Furosemide-Albumin Compared With Bumetanide in Critically Ill Patients: A Retrospective Cohort Study

Background: Continuous loop diuretics are commonly used for management of fluid overload in critically ill patients; however, diuretic resistance remains a challenge. Comparative data on the efficacy of continuous infusions of bumetanide versus furosemide-albumin in patients requiring diuresis are limited. Objective: This study aimed to assess the effects of continuous bumetanide versus continuous albumin-furosemide infusions on urine output in critically ill patients. Methods: This was a retrospective, single health-system cohort study conducted in critically ill adult patients who received continuous bumetanide or continuous albumin-furosemide infusions for at least 24 hours. The primary endpoint was cumulative urine output at 24 hours after diuretic initiation. Secondary endpoints included total diuretic dose, net fluid balance, total albumin administered, changes in serum creatinine, and serum albumin at 24 hours following diuretic initiation, intensive care unit (ICU) length of stay, and in-hospital mortality. Results: Among the 434 patients included, 173 patients received a continuous bumetanide infusion, and 261 patients received a continuous furosemide-albumin infusion. There was no significant difference in urine output at 24 hours between the bumetanide and furosemide-albumin group (3578 mL 1818-4738 vs 3617 mL 2035-4703; P = 0.304). However, patients in the bumetanide group received a significantly higher total diuretic dose in intravenous furosemide equivalents (481 mg 295-544 vs 177 mg 109-236; P < 0.001) with no difference in change in serum creatinine (0.08 mg/dL –0.19 to 0.34 vs 0.10 mg/dL –0.07 to 0.21; P = 0.597). Total albumin dose was higher in the furosemide-albumin group (10.9 g 0-12.5 vs 43.7 g 27.5-58.9; P < 0.001). Conclusion and Relevance: This is the first study to evaluate continuous infusions of bumetanide versus furosemide-albumin in critically ill patients requiring diuresis, observing a comparable urine output between diuretics. Findings indicate that bumetanide may be a reasonable alternative in fluid management.