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Use of Furosemide and Chlorothiazide Combination Continuous Infusion in Furosemide-Refractory Patients in the Pediatric Intensive Care Unit: A Retrospective Cohort Study

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Abstract

Objective

Our objective was to describe the efficacy and safety of furosemide and chlorothiazide combination continuous infusion (FCCCI) in children in a pediatric intensive care unit (ICU), including postoperative cardiac patients.

Methods

This was a retrospective cohort study in a pediatric ICU within a tertiary care teaching hospital. Children aged < 18 years admitted from 1 January 2010 to 31 December 2019 were included if they received a furosemide infusion for at least 6 h and then transitioned to FCCCI. Each patient acted as their own control.

Results

A total of 203 patients (107 [53%] postoperative cardiac) met the study inclusion criteria. The study population was 55% male and 74% Caucasian, with a median age of 4.9 months. Of the total patients, 143 (70.4%) required mechanical ventilation and 39 (19.2%) required dialysis. The median duration of furosemide and FCCCI was 24.6 h (interquartile range [IQR] 12.4–54) and 41 h (IQR 15–162), respectively. Urine output increased by 52% with FCCCI (mean increase of 2.2 mL/kg/h [95% confidence interval {CI} 1.8–2.5]; p < 0.01). The change to FCCCI led to a net negative daily fluid balance (mean difference − 301.9 mL/day [95% CI − 390.9 to − 212.9]; p < 0.01). FCCCI resulted in a greater requirement for potassium bolus supplementation (mean increase of 12.8 boluses [95% CI 8.5–17.2]; p < 0.01) and a small but statistically significant increase in serum creatinine (mean difference 0.1 mg/dL [95% CI 0.06–0.14]; p < 0.01) with a resultant decrease in estimated glomerular filtration rate (mean difference − 13.5 [95% CI 9.7–17.4]; p < 0.01). Of the furosemide-refractory patients, 78.9% were responsive to FCCCI. Younger patients and patients who underwent cardiothoracic surgery were more likely to be responsive. Nonresponders to FCCCI had slightly higher mortality (21 vs. 6.6%, p = 0.05).

Conclusions

FCCCI resulted in a significant improvement in diuresis with achievement of negative fluid balance in pediatric ICU patients. FCCCI is a reasonable approach to aggressive diuresis in the pediatric patient, particularly in patients with limited access. Serum potassium should be routinely monitored during such therapy.

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Authors and Affiliations

  1. Pharmacy Department, OSF Healthcare Saint Francis Medical Center/Children’s Hospital of Illinois, 530 NE Glen Oak AVE, Peoria, IL, 61637, USA

    Summer R. Record & Aaron A. Harthan

  2. Pediatrics Department, University of Illinois College of Medicine Peoria, OSF Healthcare Children’s Hospital of Illinois, Peoria, IL, USA

    Sandeep Tripathi

Authors
  1. Summer R. Record
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  2. Aaron A. Harthan
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Correspondence to Summer R. Record.

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Funding

No external funding was used in the preparation of this manuscript.

Conflict of Interest

Summer Record, Aaron Harthan, and Sandeep Tripathi have no potential conflicts of interest that might be relevant to the contents of this manuscript.

Ethics approval

University of Illinois College of Medicine institutional review board (IRB #1576231, 04/29/20)

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The need for informed consent was waived by the institutional review board.

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Not applicable.

Availability of data and material

Data are available upon request from the authors.

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Authors' contributions

Summer Record participated in researching previous literature, collecting data, analysis, methodology, and writing. Aaron Harthan participated in conceptualization, analysis, methodology, researching previous literature, reviewing, and editing. Sandeep Tripathi participated in project administration, conceptualization, analysis, methodology, supervision, writing, reviewing, and editing.

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Record, S.R., Harthan, A.A. & Tripathi, S. Use of Furosemide and Chlorothiazide Combination Continuous Infusion in Furosemide-Refractory Patients in the Pediatric Intensive Care Unit: A Retrospective Cohort Study. Pediatr Drugs 23, 575–582 (2021). https://doi.org/10.1007/s40272-021-00472-0

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  • DOI: https://doi.org/10.1007/s40272-021-00472-0

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