Comparison of hemodynamic and biochemical effects of continuous infusion and intermittent bolus in criticall ill patients

Background and Âdminstration Fluid balance in critically ill patients is a common problem in ÏÇÜ and is often associated with a poor outcome. Ïn addition, important clinical changes in hemodynamic variables occur after diuretic therapy. This study was conducted to evaluate the safety and relative effectiveness of two diurectic protocols in ÏÇÜ. Twenty- two ÏÇÜ patients with pulmonary edema and fluid overload and Pa Ô 2/ FiÔ2< 300 were enrolled and divided into two groups, continuos infusion or intermittent bolus, and hemodynamic and biochemical measurements were recorded. Heart rate and mean arterial pressure increased in two groups in the first hour followed by a decrease to baseline in the second hour. During this study, bolus administration led to higher increase in heart rate, blood urea nitrogen and more potassium depletion. Patients in continuous infusion group had non-significantly more cumulative urine output and less cumulative input compared with bolas group. Pa Ô2 FiÔ2, pH and ÂPÂÇHË ÏÏ (Âcute physiology and chronic health evaluation ÏÏ scoring system) significantly improved in both groups. Çonclusion: Protocol guided diuretic management can be readily implemented in ÏÇÜ. Âlthough both continuos and bolus diueretic regiments appear to be eqally effective in achieving negative fluid balance. Therefor, docters may consider a continuous infusion of furosemide in the hemodynamically and electrolytically unstable patients to ensure more controlled diuresis with less hemodynamic and electrolyte flactutions.