Ng Ka Ting, Velayit Aslinah, Khoo Delton Kah Yeang, Mohd Ismail Amirah, Mansor Marzida
Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Jalan Universiti, Kuala Lumpur, Malaysia.
International Medical University, Kuala Lumpur, Malaysia.
J Cardiothorac Vasc Anesth. 2018 Oct;32(5):2303-2310. doi: 10.1053/j.jvca.2018.01.004. Epub 2018 Jan 10.
Fluid overload is a common phenomenon seen in intensive care units (ICUs). However, there is no general consensus on whether continuous or bolus furosemide is safer or more effective in these hemodynamically unstable ICU patients. The aim of this meta-analysis was to examine the clinical outcomes of continuous versus bolus furosemide in a critically ill population in ICUs.
MEDLINE, EMBASE, PubMed, and the Cochrane Database of Systematic reviews were searched from their inception until June 2017.
All randomized controlled trials, observational studies, and case-control studies were included. Case reports, case series, nonsystematic reviews, and studies that involved children were excluded.
Nine studies (n = 464) were eligible in the data synthesis. Both continuous and bolus furosemide resulted in no difference in all-cause mortality (7 studies; n = 396; I = 0%; fixed-effect model [FEM]: odds ratio [OR] 1.15 [95% confidence interval (CI) 0.67-1.96]; p = 0.64). Continuous furosemide was associated with significant greater total urine output (n = 132; I = 70%; random-effect model: OR 811.19 [95% CI 99.84-1,522.53]; p = 0.03), but longer length of hospital stay (n = 290; I = 40%; FEM: OR 2.84 [95% CI 1.74-3.94]; p < 0.01) in comparison to the bolus group. No statistical significance was found in the changes of creatinine and estimated glomerular filtration rate between both groups.
In this meta-analysis, continuous furosemide was associated with greater diuretic effect in total urine output as compared with bolus. Neither had any differences in mortality and changes of renal function tests. However, a large adequately powered randomized clinical trial is required to fill this knowledge gap.
液体超负荷是重症监护病房（ICU）中常见的现象。然而，对于在这些血流动力学不稳定的ICU患者中，持续或大剂量注射速尿哪种更安全或更有效，目前尚无普遍共识。本荟萃分析的目的是研究在ICU危重症患者中，持续使用速尿与大剂量注射速尿的临床结局。
检索了MEDLINE、EMBASE、PubMed以及Cochrane系统评价数据库，检索时间从建库至2017年6月。
纳入所有随机对照试验、观察性研究和病例对照研究。排除病例报告、病例系列、非系统性综述以及涉及儿童的研究。
9项研究（n = 464）符合数据合成要求。持续使用速尿和大剂量注射速尿在全因死亡率方面均无差异（7项研究；n = 396；I² = 0%；固定效应模型[FEM]：比值比[OR] 1.15 [95%置信区间(CI) 0.67 - 1.96]；p = 0.64）。与大剂量注射组相比，持续使用速尿可使总尿量显著增加（n = 132；I² = 70%；随机效应模型：OR 811.19 [95% CI 99.84 - 1,522.53]；p = 0.03）但住院时间更长（n = 290；I² = 40%；FEM：OR 2.84 [95% CI 1.74 - 3.94]；p < 0.01）。两组间肌酐和估算肾小球滤过率的变化无统计学意义。
在本荟萃分析中，与大剂量注射速尿相比，持续使用速尿在总尿量方面具有更大的利尿效果。两者在死亡率和肾功能检查变化方面均无差异。然而，需要开展一项大规模、有足够效力的随机临床试验来填补这一知识空白。
