Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2015
Loop diuretic therapy in the critically ill: a survey.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Jones Sarah L, Mårtensson Johan, Glassford Neil J, Eastwood Glenn M, Bellomo Rinaldo
Аннотация
OBJECTIVES: To describe the self-reported practice of loop diuretic therapy (LDT) administration by intensivists in Australia and New Zealand and to ascertain the anticipated clinical and physiological effects of LDT for several common clinical indications.
DESIGN: Structured online questionnaire distributed to intensivists via the Australian and New Zealand Intensive Care Society Clinical Trials Group email contact list. Descriptive statistics were used to analyse the results.
PARTICIPANTS: Intensivists in Australia and New Zealand.
RESULTS: A total of 146 intensivists responded to the survey with most (99 [67.8%]) being Fellows of the College of Intensive Care Medicine or the Joint Faculty of Intensive Care Medicine. Overall, 88 (60.2%) had worked in ICUs for 10 years or more. A positive fluid balance, acute pulmonary oedema (APO) and acute lung injury (ALI) were considered key indications for LDT (> 80.0% positive response), in contrast to an elevated central venous pressure (CVP) (20.3%) and acute kidney injury (AKI) (3.8%), which were not. LDT by bolus therapy was preferred (by 60.0%-89.4%, according to indication) over continuous infusion (3.6%- 11.1%, according to indication). The dominant initial LDT dose was furosemide 40 mg as an intravenous (IV) bolus. There was a lack of consensus regarding what would be an adequate response, and for many of the clinical indications, no target was specified.
CONCLUSIONS: Australian and New Zealand intensivists typically give frusemide as a 40 mg IV bolus for a positive fluid balance, ALI and APO, but not for an elevated CVP or AKI. However, such therapy is given without explicit definitions of an adequate response under these different clinical circumstances.
DESIGN: Structured online questionnaire distributed to intensivists via the Australian and New Zealand Intensive Care Society Clinical Trials Group email contact list. Descriptive statistics were used to analyse the results.
PARTICIPANTS: Intensivists in Australia and New Zealand.
RESULTS: A total of 146 intensivists responded to the survey with most (99 [67.8%]) being Fellows of the College of Intensive Care Medicine or the Joint Faculty of Intensive Care Medicine. Overall, 88 (60.2%) had worked in ICUs for 10 years or more. A positive fluid balance, acute pulmonary oedema (APO) and acute lung injury (ALI) were considered key indications for LDT (> 80.0% positive response), in contrast to an elevated central venous pressure (CVP) (20.3%) and acute kidney injury (AKI) (3.8%), which were not. LDT by bolus therapy was preferred (by 60.0%-89.4%, according to indication) over continuous infusion (3.6%- 11.1%, according to indication). The dominant initial LDT dose was furosemide 40 mg as an intravenous (IV) bolus. There was a lack of consensus regarding what would be an adequate response, and for many of the clinical indications, no target was specified.
CONCLUSIONS: Australian and New Zealand intensivists typically give frusemide as a 40 mg IV bolus for a positive fluid balance, ALI and APO, but not for an elevated CVP or AKI. However, such therapy is given without explicit definitions of an adequate response under these different clinical circumstances.