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Furosemide versus ethacrynic acid in pediatric patients undergoing cardiac surgery: a randomized controlled trial.

Ricci Z, Haiberger R, Pezzella C, Garisto C, Favia I, Cogo P - Crit Care (2015)

Bottom Line: UO at postoperative day (POD) 0 was significantly higher in the EA group, 6.9 (3.3) ml/kg/h, compared with the F group, 4.6 (2.3) ml/kg/h (P = 0.002) but tended to be similar in the two groups thereafter.Serum creatinine, cystatin C and neutrophil gelatinase-associated lipocalin levels and incidence of acute kidney injury did not show significant differences between groups.In cardiac surgery infants, EA produced more UO compared with F on POD0.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy. z.ricci@libero.it.

ABSTRACT

Introduction: Clinical effects of furosemide (F) and ethacrynic acid (EA) continuous infusion on urine output (UO), fluid balance, and renal, cardiac, respiratory, and metabolic function were compared in infants undergoing surgery for congenital heart diseases.

Methods: A prospective randomized double-blinded study was conducted. Patients received 0.2 mg/kg/h (up to 0.8 mg/kg/h) of either F or EA.

Results: In total, 38 patients were enrolled in the F group, and 36, in the EA group. No adverse reactions were recorded. UO at postoperative day (POD) 0 was significantly higher in the EA group, 6.9 (3.3) ml/kg/h, compared with the F group, 4.6 (2.3) ml/kg/h (P = 0.002) but tended to be similar in the two groups thereafter. Mean administered F dose was 0.33 (0.19) mg/kg/h compared with 0.22 (0.13) mg/kg/h of EA (P < 0.0001). Fluid balance was significantly more negative in the EA group at postoperative day 0: -43 (54) ml/kg/h versus -17 (32) ml/kg/h in the F group (P = 0.01). Serum creatinine, cystatin C and neutrophil gelatinase-associated lipocalin levels and incidence of acute kidney injury did not show significant differences between groups. Metabolic alkalosis occurred frequently (about 70% of cases) in both groups, but mean bicarbonate level was higher in the EA group: 27.8 (1.5) M in the F group versus 29.1 (2) mM in the EA group (P = 0.006). Mean cardiac index (CI) values were 2.6 (0.1) L/min/m(2) in the F group compared with 2.98 (0.09) L/min/m(2) in the EA group (P = 0.0081). Length of mechanical ventilation was shorter in the EA group, 5.5 (8.8) days compared with the F group, 6.7 (5.9) (P = 0.06). Length of Pediatric Cardiac Intensive Care Unit (PCICU) admission was shorter in the EA group: 14 (19) days compared with 16 (15) in the F group (P = 0.046).

Conclusions: In cardiac surgery infants, EA produced more UO compared with F on POD0. Generally, a smaller EA dose is required to achieve similar UO than F. EA and F were safe in terms of renal function, but EA caused a more-intense metabolic alkalosis. EA patients achieved better CI, and shorter mechanical ventilation and PCICU admission time.

Trial registration: Clinicaltrials.gov NCT01628731. Registered 24 June 2012.

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Related in: MedlinePlus

Fluid balance (FB) per kilogram of patient body weight in the three study days in the furosemide (F) and ethacrynic acid (EA) groups. *P < 0.05. POD, postoperative day. Data are expressed as average and standard deviation.
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Fig2: Fluid balance (FB) per kilogram of patient body weight in the three study days in the furosemide (F) and ethacrynic acid (EA) groups. *P < 0.05. POD, postoperative day. Data are expressed as average and standard deviation.

Mentions: The primary end point (UO at POD0) was 6.9 (3.3) ml/kg/h in the EA group, which was significantly higher than 4.6 (2.3) ml/kg/h (P = 0.002) in the F group. UO in the following days tended to be similar in the two groups, without significant differences (Figure 1A). However, mean diuretic dose was significantly different in the two groups throughout the study period: overall, mean administered furosemide was 0.33 (0.19) mg/kg/h, whereas mean administered EA was 0.22 (0.13) mg/kg/h (P < 0.0001): it can be assumed that for a similar UO, about 30% less EA was needed. A daily diuretic dose above 0.4 mg/kg/h was administered to three patients in the L group (two of these received 0.8 mg/kg/h for 24 hours, and one received 0.5 mg/kg/h for 48 hours) and to one patient in the EA group (0.5 mg/kg/h for 24 hours). The mean UO levels indexed over mean diuretic dose were significantly different in the two groups at every time point (<0.01) (Figure 1B). Fluid balance was significantly more negative in the EA group at POD0: −43 (54) ml/kg/h compared with −17 (32) ml/kg/h (P = 0.01) in the F group. Thereafter, fluid balance was similar in the two groups (Figure 2).Figure 1


Furosemide versus ethacrynic acid in pediatric patients undergoing cardiac surgery: a randomized controlled trial.

Ricci Z, Haiberger R, Pezzella C, Garisto C, Favia I, Cogo P - Crit Care (2015)

Fluid balance (FB) per kilogram of patient body weight in the three study days in the furosemide (F) and ethacrynic acid (EA) groups. *P < 0.05. POD, postoperative day. Data are expressed as average and standard deviation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4305226&req=5

Fig2: Fluid balance (FB) per kilogram of patient body weight in the three study days in the furosemide (F) and ethacrynic acid (EA) groups. *P < 0.05. POD, postoperative day. Data are expressed as average and standard deviation.
Mentions: The primary end point (UO at POD0) was 6.9 (3.3) ml/kg/h in the EA group, which was significantly higher than 4.6 (2.3) ml/kg/h (P = 0.002) in the F group. UO in the following days tended to be similar in the two groups, without significant differences (Figure 1A). However, mean diuretic dose was significantly different in the two groups throughout the study period: overall, mean administered furosemide was 0.33 (0.19) mg/kg/h, whereas mean administered EA was 0.22 (0.13) mg/kg/h (P < 0.0001): it can be assumed that for a similar UO, about 30% less EA was needed. A daily diuretic dose above 0.4 mg/kg/h was administered to three patients in the L group (two of these received 0.8 mg/kg/h for 24 hours, and one received 0.5 mg/kg/h for 48 hours) and to one patient in the EA group (0.5 mg/kg/h for 24 hours). The mean UO levels indexed over mean diuretic dose were significantly different in the two groups at every time point (<0.01) (Figure 1B). Fluid balance was significantly more negative in the EA group at POD0: −43 (54) ml/kg/h compared with −17 (32) ml/kg/h (P = 0.01) in the F group. Thereafter, fluid balance was similar in the two groups (Figure 2).Figure 1

Bottom Line: UO at postoperative day (POD) 0 was significantly higher in the EA group, 6.9 (3.3) ml/kg/h, compared with the F group, 4.6 (2.3) ml/kg/h (P = 0.002) but tended to be similar in the two groups thereafter.Serum creatinine, cystatin C and neutrophil gelatinase-associated lipocalin levels and incidence of acute kidney injury did not show significant differences between groups.In cardiac surgery infants, EA produced more UO compared with F on POD0.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology and Cardiac Surgery, Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy. z.ricci@libero.it.

ABSTRACT

Introduction: Clinical effects of furosemide (F) and ethacrynic acid (EA) continuous infusion on urine output (UO), fluid balance, and renal, cardiac, respiratory, and metabolic function were compared in infants undergoing surgery for congenital heart diseases.

Methods: A prospective randomized double-blinded study was conducted. Patients received 0.2 mg/kg/h (up to 0.8 mg/kg/h) of either F or EA.

Results: In total, 38 patients were enrolled in the F group, and 36, in the EA group. No adverse reactions were recorded. UO at postoperative day (POD) 0 was significantly higher in the EA group, 6.9 (3.3) ml/kg/h, compared with the F group, 4.6 (2.3) ml/kg/h (P = 0.002) but tended to be similar in the two groups thereafter. Mean administered F dose was 0.33 (0.19) mg/kg/h compared with 0.22 (0.13) mg/kg/h of EA (P < 0.0001). Fluid balance was significantly more negative in the EA group at postoperative day 0: -43 (54) ml/kg/h versus -17 (32) ml/kg/h in the F group (P = 0.01). Serum creatinine, cystatin C and neutrophil gelatinase-associated lipocalin levels and incidence of acute kidney injury did not show significant differences between groups. Metabolic alkalosis occurred frequently (about 70% of cases) in both groups, but mean bicarbonate level was higher in the EA group: 27.8 (1.5) M in the F group versus 29.1 (2) mM in the EA group (P = 0.006). Mean cardiac index (CI) values were 2.6 (0.1) L/min/m(2) in the F group compared with 2.98 (0.09) L/min/m(2) in the EA group (P = 0.0081). Length of mechanical ventilation was shorter in the EA group, 5.5 (8.8) days compared with the F group, 6.7 (5.9) (P = 0.06). Length of Pediatric Cardiac Intensive Care Unit (PCICU) admission was shorter in the EA group: 14 (19) days compared with 16 (15) in the F group (P = 0.046).

Conclusions: In cardiac surgery infants, EA produced more UO compared with F on POD0. Generally, a smaller EA dose is required to achieve similar UO than F. EA and F were safe in terms of renal function, but EA caused a more-intense metabolic alkalosis. EA patients achieved better CI, and shorter mechanical ventilation and PCICU admission time.

Trial registration: Clinicaltrials.gov NCT01628731. Registered 24 June 2012.

Show MeSH
Related in: MedlinePlus