Clinical outcomes of a furosemide infusion protocol in edematous patients in the intensive care unit.

BACKGROUND: Many critically ill patients have severe volume overload due to vigorous fluid resuscitation. Optimal fluid management strategies to clear tissue edema are unclear. OBJECTIVE: To assess safety and effectiveness of a clinical application of a furosemide infusion protocol in edematous critically ill patients. METHODS: A prospective, cohort study of consecutive adult critically ill patients who received furosemide infusion by protocol from June 2003 to July 2004. RESULTS: The mean total dose of furosemide was 2240 mg. The mean cumulative fluid balance therapy was -3376 mL. Electrolyte values in the critical laboratory range were 3.3% for potassium, 0.2% for sodium, and no critical values for magnesium. The mean change in creatinine level was +0.2 mg/dL during furosemide infusion therapy, but the mean creatinine level returned to baseline by 3 days after the furosemide infusion. A minimum mean arterial pressure less than 55 mm Hg occurred 12% of the time during the furosemide infusion. CONCLUSIONS: Furosemide infusion therapy was associated with moderately negative cumulative fluid balances, electrolyte shifts, and mild transient worsening of renal function.