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Patterns of diuretic use in the intensive care unit

PURPOSE: To inform future outcomes research on diuretics, we sought to describe modern patterns of diuretic use in the intensive care unit (ICU), including diuretic type, combination, and dosing. We also investigated two possible quality improvement targets: furosemide dosing in renal impairment and...

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Detalles Bibliográficos
Autores principales: McCoy, Ian Ellis, Chertow, Glenn Matthew, Chang, Tara I-Hsin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6544280/
https://www.ncbi.nlm.nih.gov/pubmed/31150512
http://dx.doi.org/10.1371/journal.pone.0217911
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author McCoy, Ian Ellis
Chertow, Glenn Matthew
Chang, Tara I-Hsin
author_facet McCoy, Ian Ellis
Chertow, Glenn Matthew
Chang, Tara I-Hsin
author_sort McCoy, Ian Ellis
collection PubMed
description PURPOSE: To inform future outcomes research on diuretics, we sought to describe modern patterns of diuretic use in the intensive care unit (ICU), including diuretic type, combination, and dosing. We also investigated two possible quality improvement targets: furosemide dosing in renal impairment and inclusion of an initial bolus with continuous furosemide infusions. MATERIALS AND METHODS: In this descriptive study, we retrospectively studied 46,037 adult ICU admissions from a publicly available database of patients in an urban, academic medical center. RESULTS: Diuretics were employed in nearly half (49%, 22,569/46,037) of ICU admissions. Mechanical ventilation, a history of heart failure, and admission to the post-cardiac surgery unit were associated with a higher frequency of diuretic use. Combination use of different diuretic classes was uncommon. Patients with severely impaired kidney function were less likely to receive diuretics. Furosemide was by far the most common diuretic given and the initial intravenous dose was only 20 mg in more than half of ICU admissions. Among patients treated with a continuous infusion, 30% did not receive a bolus on the day of infusion initiation. CONCLUSIONS: Patterns of diuretic use varied by patient-specific factors and by ICU type. Diuretic dosing strategies may be suboptimal.
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spelling pubmed-65442802019-06-17 Patterns of diuretic use in the intensive care unit McCoy, Ian Ellis Chertow, Glenn Matthew Chang, Tara I-Hsin PLoS One Research Article PURPOSE: To inform future outcomes research on diuretics, we sought to describe modern patterns of diuretic use in the intensive care unit (ICU), including diuretic type, combination, and dosing. We also investigated two possible quality improvement targets: furosemide dosing in renal impairment and inclusion of an initial bolus with continuous furosemide infusions. MATERIALS AND METHODS: In this descriptive study, we retrospectively studied 46,037 adult ICU admissions from a publicly available database of patients in an urban, academic medical center. RESULTS: Diuretics were employed in nearly half (49%, 22,569/46,037) of ICU admissions. Mechanical ventilation, a history of heart failure, and admission to the post-cardiac surgery unit were associated with a higher frequency of diuretic use. Combination use of different diuretic classes was uncommon. Patients with severely impaired kidney function were less likely to receive diuretics. Furosemide was by far the most common diuretic given and the initial intravenous dose was only 20 mg in more than half of ICU admissions. Among patients treated with a continuous infusion, 30% did not receive a bolus on the day of infusion initiation. CONCLUSIONS: Patterns of diuretic use varied by patient-specific factors and by ICU type. Diuretic dosing strategies may be suboptimal. Public Library of Science 2019-05-31 /pmc/articles/PMC6544280/ /pubmed/31150512 http://dx.doi.org/10.1371/journal.pone.0217911 Text en © 2019 McCoy et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
McCoy, Ian Ellis
Chertow, Glenn Matthew
Chang, Tara I-Hsin
Patterns of diuretic use in the intensive care unit
title Patterns of diuretic use in the intensive care unit
title_full Patterns of diuretic use in the intensive care unit
title_fullStr Patterns of diuretic use in the intensive care unit
title_full_unstemmed Patterns of diuretic use in the intensive care unit
title_short Patterns of diuretic use in the intensive care unit
title_sort patterns of diuretic use in the intensive care unit
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6544280/
https://www.ncbi.nlm.nih.gov/pubmed/31150512
http://dx.doi.org/10.1371/journal.pone.0217911
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