Continuous loop-diuretic infusion and thiazide- or acetazolamide-loop diuretic combinations in- creased urine output significantly in critically ill patients, leading to a negative fluid balance and weight loss, according to a study published in the Journal of Critical Care. Researchers sought to investigate various diuretic strategies to alleviate loop-diuretics resistance in critically ill adult pa- tients in the ICU requiring more than 1 mg/kg/ day of furosemide. Four diuretic strategies were investigated: incremental dose of loop diuretics, continuous infusion, combinations with a second class of diuretics, and administration of intrave- nous albumin. A generalized estimating equation was used to investigate the associations between these strategies and endpoints. The primary out- come was the 24-hour urine output, and secondary endpoints included fluid balance, weight change, electrolyte and acid-base abnormalities, kidney replacement therapy initiation, and mortality. A total of 7,645 ICU stays from 6,358 patients were included. After adjustment, the researchers found that the use of continuous loop-diuretic infusion was associated with a higher 24-hour urine out- put (: 732, 95% CI: 669-795), lower 24-hour fluid balance, and greater weight loss at 48 hours. In addition, thiazide- and carbonic anhydrase in- hibitor combinations were both associated with higher urine output and weight loss at 48 hours, while intravenous albumin was associated with fluid gain. Risks of electrolyte and metabolic dis- turbances varied across diuretic strategies.
