Comparison between Torsemide Infusion Versus Intermittent Boluses and Their Impact-On Thoracic Fluid Content in Acute Decompensated Heart Failure Critically Ill Patients

Saeed, Mohammed Abdel Monem; Waheed, Tamer; Hussein, Alaa; Mohammed, Deyaa

doi:10.21608/ejhm.2023.280206

Comparison between Torsemide Infusion Versus Intermittent Boluses and Their Impact-On Thoracic Fluid Content in Acute Decompensated Heart Failure Critically Ill Patients

Document Type : Original Article

Authors

Critical care medicine department, faculty of medicine Helwan University,Cairo,Egypt.

10.21608/ejhm.2023.280206

Abstract

Background: It is still debatable whether loop diuretics should be given intravenously as boluses or continuously by infusion while treating acute decompensated heart failure (ADHF).
Objective: We aimed to evaluate the differences between the two administration routes on the thoracic fluid content (TFC), renal functions, urine output, electrolytes, haemodynamic parameters, echo cardiographic parameters, incidence of atrial fibrillation and NYHA class.
Patients and methods: Eight hundred thirty patients admitted to the Critical Care Medicine Department, Faculty of Medicine Helwan University, Egypt with acute decompensated heart failure (ADHF) were enrolled in the study; thirty patients were excluded due to EF>40%, myocardial infarction within 30 days and baseline creatinine level > 4 mg/dl. Torsemide 200 mg per day was given to the remaining 800 patients who continued in the study after 1:1 randomization to either continuous intravenous infusion (group I, 400 patients), or twice equal intermittently daily doses (group II, 400 patients). No subsequent dose titration done all over the first 4 days.
Results: The delta TFC all through the four days were all statistically significant giving the superiority of the infusion route over the twice daily regimen. While urine output was increased all through the four days, with significant statistical difference in favor of the infusion group but creatinine level, urea level, creatinine clearance were all non-significant statistically when comparing the two groups. The NYHA class started to be significant statistically from the third and fourth days in favor of infusion group.
Conclusions: We concluded that torsemide infusion when compared to the torsemide twice equal dose in ADHF, causes more decrease in TFC, symptomatic improvement with non-significant nephrotoxic effects.

Keywords