ABSTRACT
BACKGROUND: Many critically ill patients have severe volume overload due to vigorous fluid resuscitation. Optimal fluid management strategies to clear tissue edema are unclear. OBJECTIVE: To assess safety and effectiveness of a clinical application of a furosemide infusion protocol in edematous critically ill patients. METHODS: A prospective, cohort study of consecutive adult critically ill patients who received furosemide infusion by protocol from June 2003 to July 2004. RESULTS: The mean total dose of furosemide was 2240 mg. The mean cumulative fluid balance therapy was -3376 mL. Electrolyte values in the critical laboratory range were 3.3% for potassium, 0.2% for sodium, and no critical values for magnesium. The mean change in creatinine level was +0.2 mg/dL during furosemide infusion therapy, but the mean creatinine level returned to baseline by 3 days after the furosemide infusion. A minimum mean arterial pressure less than 55 mm Hg occurred 12% of the time during the furosemide infusion. CONCLUSIONS: Furosemide infusion therapy was associated with moderately negative cumulative fluid balances, electrolyte shifts, and mild transient worsening of renal function.
Subject(s)
Diuretics/administration & dosage , Edema/drug therapy , Furosemide/administration & dosage , Intensive Care Units , Water-Electrolyte Imbalance/drug therapy , Adult , Aged , Aged, 80 and over , Cohort Studies , Critical Care , Critical Illness/mortality , Critical Illness/therapy , Diuretics/adverse effects , Dose-Response Relationship, Drug , Edema/diagnosis , Female , Follow-Up Studies , Furosemide/adverse effects , Glomerular Filtration Rate/drug effects , Humans , Infusions, Intravenous , Kidney Function Tests , Male , Middle Aged , Patient Safety , Prospective Studies , Risk Assessment , Survival Rate , Treatment Outcome , Water-Electrolyte Imbalance/physiopathologyABSTRACT
OBJECTIVE: To determine whether early activity is feasible and safe in respiratory failure patients. DESIGN: Prospective cohort study. SETTING: From June 1, 2003, through December 31, 2003, we assessed safety and feasibility of early activity in all consecutive respiratory failure patients who required mechanical ventilation for >4 days admitted to our respiratory intensive care unit (RICU). A majority of patients were treated in another intensive care unit (ICU) before RICU admission. We excluded patients who required mechanical ventilation for < or =4 days. PATIENTS: Eight-bed RICU at LDS Hospital. INTERVENTIONS: We assessed patients for early activity as part of routine respiratory ICU care. We prospectively recorded activity events and adverse events. We defined three activity events as sit on bed, sit in chair, and ambulate. We defined six activity-related adverse events as fall to knees, tube removal, systolic blood pressure >200 mm Hg, systolic blood pressure <90 mm Hg, oxygen desaturation <80%, and extubation. MEASUREMENTS AND MAIN RESULTS: During the study period, we conducted a total of 1,449 activity events in 103 patients. The activity events included 233 (16%) sit on bed, 454 (31%) sit in chair, and 762 (53%) ambulate. In patients with an endotracheal tube in place, there were a total of 593 activity events, of which 249 (42%) were ambulation. There were <1% activity-related adverse events, including fall to the knees without injury, feeding tube removal, systolic blood pressure >200 mm Hg, systolic blood pressure <90 mm Hg, and desaturation <80%. No patient was extubated during activity. CONCLUSIONS: We conclude that early activity is feasible and safe in respiratory failure patients. A majority of survivors (69%) were able to ambulate >100 feet at RICU discharge. Early activity is a candidate therapy to prevent or treat the neuromuscular complications of critical illness.
