Absence of tolerance and toxicity to high-dose continuous intravenous furosemide in haemodynamically unstable infants after cardiac surgery

摘要

What is already known about this subject ? Continous i.v. infusion of furosemide is superior to intermittent administrations, especially in haemodynamically unstable infants, because it results in a more controlled diuresis (although doses are generally chosen rather low). What this study adds ? High-dose continuous furosemide infusion is an effective treatment for volume overload in haemodynamically unstable infants. ? Development of tolerance to furosemide was not observed despite high doses and prolonged exposure. ? Maximum serum furosemide concentrations remained well below the presumed toxic concentration. Aim To evaluate a high-dose continuous furosemide regimen in infants after cardiac surgery. Methods Fifteen haemodynamically unstable infants with volume overload admitted to a paediatric intensive care unit were treated with an aggressive furosemide regimen consisting of a loading bolus (1–2 mg kg ^?1 ) followed by a continuous infusion at 0.2 mg kg ^?1 h ^?1 which was adjusted according to a target urine output of 4 ml kg ^?1 h ^?1 . Frequent sampling for furosemide concentrations in blood and urine was done for 3 days with simultaneous assessment of sodium excretion and urine output. Results The mean furosemide dose was 0.22 (± 0.06), 0.25 (± 0.10) and 0.22 (± 0.11) mg kg ^?1 h ^?1 on the first, second and third day, respectively. Median urine production was 3.0 (0.6–5.3), 4.2 (1.7–6.6) and 3.9 (2.0–8.5) ml kg ^?1 h ^?1 , respectively, on the first, second and third day of the study. The target urine production was reached at a median time of 24 (6–60) h and this was maintained during the study period. The regimen did not result in toxic serum concentrations and was haemodynamically well tolerated. Conclusion High-dose continuous furosemide infusion for 72 h in haemodynamically unstable infants after cardiac surgery appears to be a safe and effective treatment for volume overload. Development of tolerance against the effects of furosemide and ototoxic furosemide concentrations were not observed.