Schuller D, Lynch J P, Fine D
John Cochran Veterans Affairs Medical Center, St. Louis, MO, USA.
Crit Care Med. 1997 Dec;25(12):1969-75. doi: 10.1097/00003246-199712000-00011.
To evaluate the safety and relative effectiveness of two diuretic protocols in the intensive care unit (ICU).
Prospective, randomized comparative study.
Thirty-three cardiac and medical ICU patients with pulmonary edema or fluid overload for which aggressive diuresis was intended.
Enrolled patients were randomized to fluid management strategies combining fluid restriction and individually adjusted diuretic therapy by either continuous or bolus infusions of furosemide, titrated to achieve negative hourly fluid balance.
Cumulative intake minus output (primary endpoint); change in serum creatinine, and length of ICU and hospital stay (secondary endpoints). Diuresis by either protocol was feasible, safe, and effective. The main outcome measures were not significantly different for either group managed with a standardized protocol.
Protocol-guided diuretic management, with individualized titration of dosage to defined physiologic endpoints can be readily and safely implemented in the ICU. Both continuous and bolus diuretic regimens appear equally effective in achieving negative fluid balance. Larger studies with a randomized control arm are needed before these protocols can be recommended as routine practice.
评估重症监护病房（ICU）中两种利尿方案的安全性和相对有效性。
前瞻性随机对照研究。
33例因肺水肿或液体超负荷而需要积极利尿治疗的心脏和内科ICU患者。
将入选患者随机分为液体管理策略组，该策略结合液体限制和通过持续或大剂量静脉注射呋塞米进行个体化调整的利尿治疗，滴定以实现每小时液体负平衡。
累积摄入量减去排出量（主要终点）；血清肌酐变化、ICU住院时间和住院时间（次要终点）。两种方案的利尿治疗均可行、安全且有效。采用标准化方案管理的两组患者的主要结局指标无显著差异。
在ICU中，可以轻松且安全地实施方案指导的利尿管理，并根据定义的生理终点对剂量进行个体化滴定。持续和大剂量利尿方案在实现液体负平衡方面似乎同样有效。在这些方案被推荐作为常规做法之前，需要进行更大规模的随机对照研究。
