Diuretics in acute decompensated CHF - PulmCCM
Mar 062011

How "hard" should we "hit" our patients with Lasix? And does that hurt? Felker et al asked that (sort of) in a NHLBI-funded trial. They gave furosemide to 308 patients hospitalized for ADHF in an IV dose either equivalent to their home dose, or at 2.5 times their home dose, and either at q12-hour intervals or by continuous infusion (i.e., patients assigned to one of four groups in a 2x2 table). No one method was superior on the primary endpoint (a composite global assessment of symptoms). Higher doses of Lasix resulted in more fluid output, without significant renal failure. Continuous drips were not superior to bolus infusion in safety or efficacy.(n=308). NEJM 2011;364:797-805.

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  One Response to “Diuretics in acute decompensated CHF”

  1. I think the most interesting part of that study is the fact that the higher doses of lasix and subsequent increased diuresis did NOT result in more renal failure, which is a common dogmatic belief which often impedes appropriate therapy. This knowledge should be more widespread…

    I have a post on this topic at http://thinkingcriticalcare.com for those interested in more detail…

    Philippe Rola