Lasix - bolus or continuous infusion?

Very interesting study published recently in NEJM looking into diuretic strategies in patients with acute decompensated heart failure.

In a prospective, double-blind, randomized trial, 308 patients with acute decompensated heart failure were assigned to receive furosemide administered intravenously by means of either a bolus every 12 hours or continuous infusion and at either a low dose (equivalent to the patient's previous oral dose) or a high dose (2.5 times the previous oral dose). The protocol allowed specified dose adjustments after 48 hours.

In the comparison of bolus with continuous infusion, there was no significant difference in patients' global assessment of symptoms or in the mean change in the creatinine level.

In the comparison of the high-dose strategy with the low-dose strategy, there was a nonsignificant trend toward greater improvement in patients' global assessment of symptoms in the high-dose group. The high-dose strategy was associated with greater diuresis and more favorable outcomes in some secondary measures but also with transient worsening of renal function.

It was concluded that among patients with acute decompensated heart failure, there were no significant differences in patients' global assessment of symptoms or in the change in renal function when diuretic therapy was administered by bolus as compared with continuous infusion or at a high dose as compared with a low dose.


Diuretic Strategies in Patients with Acute Decompensated Heart Failure, N Engl J Med 2011; 364:797-805, March 3, 2011