Comparative effectiveness and safety of bolus vs. continuous infusion of loop diuretics: Results from the MIMIC-III Database

and several studies have demonstrated a correlation between fluid overload and adverse outcomes. ^, Conservative fluid management can improve the oxygenation index, increase the number of ventilator-free days, and shorten the stay in the intensive care unit (ICU). Loop diuretics administration is a well-established therapy that can decrease the incidence of fluid overload. Continuous infusion and bolus injection of diuretics are two methods that physicians can use to achieve their fluid management goals. However, there is still not enough evidence to indicate which strategy is better in terms of safety and efficiency. The randomized controlled Diuretic Optimization Strategies Evaluation in Acute Heart Failure (DOSE) study found no significant difference in patients’ global assessment of symptoms or in the change in renal function in a large group of patients with decompensated heart failure, when diuretics were administered by bolus as compared with continuous infusion. Other randomized controlled trials have yielded conflicting results in patients with heart failure. However, most of the studies only enrolled outpatients, who were very different from patients in the ICU. A recent meta-analysis reported that the beneficial effect on total urine output was greater when continuous furosemide was administered than when a bolus injection was delivered.

However, most of the randomized controlled trials included in that meta-analysis had small sample sizes.

Patients in the ICU have a high incidence of acute kidney injury (AKI) and are more vulnerable and more complicated to manage than the patients in a general medicine ward or outpatient. An appropriate diuretic strategy is needed to help physicians achieve their fluid management goals when a patient needs an increased dose of diuretics. The aim of this study was to compare the efficiency and safety of two diuretic strategies in a relatively large sample of patients who were admitted to the ICU based on the Medical Information Mart for Intensive Care (MIMIC)-III database.