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Review
. 2023 Feb 8;15(2):e34758.
doi: 10.7759/cureus.34758. eCollection 2023 Feb.

Continuous Infusion Versus Bolus Injection of Loop Diuretics for Patients With Congestive Heart Failure: A Meta-Analysis

Jithin Karedath  1 , Anim Asif  2 , Niharika Tentu  3 , Tafseer Zahra  4 , Saima Batool  5 , Meenakshi Sathish  6 , Qudsia I Sandhu  7 , Areeba Khan  8
Affiliations
Review

Continuous Infusion Versus Bolus Injection of Loop Diuretics for Patients With Congestive Heart Failure: A Meta-Analysis

Jithin Karedath et al. Cureus. .

Abstract

Loop diuretics continue to be a crucial component of pharmacological treatment, to eliminate extra fluid and enhance symptom control in acute decompensated heart failure (ADHF). Understanding the loop diuretics' more efficient form of administration would be very beneficial in improving the management of people's ADHF, resulting in a quicker resolution of symptoms and a notable decrease in morbidity. To assess the outcomes of intravenous continuous infusion with bolus injection of loop diuretics for patients with ADHF, this meta-analysis was carried out. The current meta-analysis was conducted as per the Cochrane Collaboration guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension (PRISMA) guidelines. A search was carried out on PubMed and EMBASE databases for studies comparing continuous infusion with intermittent bolus injection of furosemide in patients with congestive heart failure without restriction on the language of publication from 1 January 2001 to 31 July 2022. The primary outcome of the meta-analysis was all-cause mortality and loss of body weight (kg). Pre-defined secondary outcomes included length of hospital stay (LOS) in days, brain natriuretic peptide (BNP) reduction (pg/ml), number of patients with hypokalemia, and urine output at 24 hours (ml). A total of nine articles were included in this meta-analysis enrolling 713 patients. No significant difference was reported between patients who received intermittent bolus injections and continuous infusion of furosemide in regards to all-cause mortality, LOS, total urine output, the incidence of hypokalemia, and change in BNP. However, the reduction of body weight was greater in the continuous infusion group compared to bolus administration. In conclusion, in the current meta-analysis of nine randomized controlled trials (RCTs), continuous infusion of furosemide seemed to have a greater reduction of body weight. However, no significant difference was there in 24-hrs urine output. However, we cannot conclude that intravenous continuous infusion has a better diuretic effect compared to bolus administration.

Keywords: acute decompensated heart failure; bolus administration; continuous infusion; furosemide; loop diuretic.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. PRISMA flowchart of selection of studies
ADHF: acute decompensated heart failure
Figure 2
Figure 2. Risk of bias assessment
Figure 3
Figure 3. Forest plot of all-cause mortality
Sources: References [6,12-14] CI: confidence interval
Figure 4
Figure 4. Forest plot of length of hospitalization
Sources: References [6,12-18] SD: standard deviation; IV: intravenous; CI: confidence interval
Figure 5
Figure 5. Forest plot of reduction in body weight (kg)
Sources: References [6,12,13,16-19] SD: standard deviation; IV: intravenous; CI: confidence interval
Figure 6
Figure 6. Forest plot of total urine output in 24 hours (ml)
Sources: References [10,13-16,18] SD: standard deviation; IV: intravenous; CI: confidence interval
Figure 7
Figure 7. Forest plot for reduction of BNP
Sources: References [6,13,18] SD: standard deviation; IV: intravenous; CI: confidence interval; BNP: brain natriuretic peptide
Figure 8
Figure 8. Forest plot of hypokalemia
Sources: References [10,12,18] CI: confidence interval
See this image and copyright information in PMC

References

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