Escudero Victor Joaquin, Mercadal Jordi, Molina-Andújar Alícia, Piñeiro Gaston J, Cucchiari David, Jacas Adriana, Carramiñana Albert, Poch Esteban
Nephrology and Kidney Transplantation Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
Surgical Intensive Care Unit, Anesthesiology Department, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Univesitat de Barcelona, Barcelona, Spain.
Front Nephrol. 2022 Jul 8;2:879766. doi: 10.3389/fneph.2022.879766. eCollection 2022.
Diuretics are commonly used in critically ill patients with acute kidney injury (AKI) and fluid overload in intensive care units (ICU), furosemide being the diuretic of choice in more than 90% of the cases. Current evidence shows that other diuretics with distinct mechanisms of action could be used with good results in patients with selected profiles. From acetazolamide to tolvaptan, we will discuss recent studies and highlight how specific diuretic mechanisms could help to manage different ICU problems, such as loop diuretic resistance, hypernatremia, hyponatremia, or metabolic alkalosis. The current review tries to shed some light on the potential use of non-loop diuretics based on patient profile and give recommendations for loop diuretic treatment performance focused on what the intensivist and critical care nephrologist need to know based on the current evidence.
利尿剂常用于重症监护病房（ICU）中患有急性肾损伤（AKI）和液体超负荷的重症患者，在超过90%的病例中，呋塞米是首选利尿剂。目前的证据表明，其他具有不同作用机制的利尿剂可用于特定情况的患者，并取得良好效果。从乙酰唑胺到托伐普坦，我们将讨论近期的研究，并强调特定的利尿机制如何有助于处理不同的ICU问题，如袢利尿剂抵抗、高钠血症、低钠血症或代谢性碱中毒。本综述旨在根据患者情况阐明非袢利尿剂的潜在用途，并根据当前证据，针对袢利尿剂治疗效果给出建议，这些建议是基于重症监护医生和重症监护肾病专家需要了解的内容。
