Diuretics decrease fluid balance in patients on invasive mechanical ventilation: the randomized-controlled single blind, IRIHS study
Abstract Background Fluid overload has been associated with increased morbidity and mortality in critically ill patients. The goal of this study was to assess the efficacy and safety of a diuretic strategy to overcome positive fluid balance in patients on invasive mechanical ventilation. Methods Des...
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| Format: | Article |
| Language: | English |
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BMC
2021-03-01
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| Series: | Critical Care |
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| Online Access: | https://doi.org/10.1186/s13054-021-03509-5 |
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| author | Raphaël Cinotti Jean-Baptiste Lascarrou Marie-Ange Azais Gwenhaël Colin Jean-Pierre Quenot Pierre-Joachim Mahé Antoine Roquilly Aurélie Gaultier Karim Asehnoune Jean Reignier |
| author_facet | Raphaël Cinotti Jean-Baptiste Lascarrou Marie-Ange Azais Gwenhaël Colin Jean-Pierre Quenot Pierre-Joachim Mahé Antoine Roquilly Aurélie Gaultier Karim Asehnoune Jean Reignier |
| author_sort | Raphaël Cinotti |
| collection | DOAJ |
| description | Abstract Background Fluid overload has been associated with increased morbidity and mortality in critically ill patients. The goal of this study was to assess the efficacy and safety of a diuretic strategy to overcome positive fluid balance in patients on invasive mechanical ventilation. Methods Design: Multicenter, single-blind, randomized-controlled study. Patients were randomized into a diuretic (furosemide) or a control group. Patients were eligible in case of fluid overload defined as in-ICU weight increase ≥ 3%, invasive mechanical ventilation (FiO2 ≤ 60% and PEEP ≤ 10 cm H2O on inclusion) and hemodynamic stabilization. The primary outcome was fluid balance, defined as weight variation from reference weight to successful extubation. The main secondary outcome was the safety of diuretic. Results 171 patients were randomized. After 5 exclusions, 166 patients were included in the analysis: 77 in the diuretic and 89 in the control group. Fluid balance was 1.4 [− 2.5 to 4.5] kg in the diuretic and 6.4 [0.5–11.2] kg in the control group (p < 0.001). In the multiple imputation analysis, fluid balance was significantly decreased in the diuretic group (mean difference = − 4.8 95% CI [− 7.3 to − 2.5], p < 0.001). Eleven (14%) patients died in the diuretic group and 16 (18%) patients in the control group (p = 0.5). There was a worsening of Acute Kidney Injury in 67 (75.3%) patients of the control group versus 46 (59.7%) patients in the diuretic group (p = 0.03). Conclusions In this multicenter randomized-controlled study, protocolized diuretic therapy reduced fluid accumulation in patients receiving mechanical ventilation and was well tolerated with a favorable safety profile. Trial registration NCT 02345681, Registered January 26 2015, Prospectively registered, https://clinicaltrials.gov/ct2/show/NCT02345681?term=02345681&draw=2&rank=1 . |
| first_indexed | 2024-12-16T18:30:54Z |
| format | Article |
| id | doaj.art-51f4f24a17714219a321dd49201c651a |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-16T18:30:54Z |
| publishDate | 2021-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-51f4f24a17714219a321dd49201c651a2022-12-21T22:21:17ZengBMCCritical Care1364-85352021-03-012511910.1186/s13054-021-03509-5Diuretics decrease fluid balance in patients on invasive mechanical ventilation: the randomized-controlled single blind, IRIHS studyRaphaël Cinotti0Jean-Baptiste Lascarrou1Marie-Ange Azais2Gwenhaël Colin3Jean-Pierre Quenot4Pierre-Joachim Mahé5Antoine Roquilly6Aurélie Gaultier7Karim Asehnoune8Jean Reignier9CHU Nantes, Pôle Anesthésie-Réanimation, Service d’Anesthésie Réanimation Chirurgicale, Hôpital Guillaume et René Laennec, Université de NantesMédecine Intensive et Réanimation, Hôtel Dieu, University Hospital of NantesMédecine Intensive et Réanimation, Centre Hospitalier Départemental de la VendéeMédecine Intensive et Réanimation, Centre Hospitalier Départemental de la VendéeService de Médecine Intensive-Réanimation, CHU Dijon-BourgogneCHU Nantes, Pôle Anesthésie-Réanimation, Service d’Anesthésie Réanimation Chirurgicale, Hôtel Dieu, Université de NantesCHU Nantes, Pôle Anesthésie-Réanimation, Service d’Anesthésie Réanimation Chirurgicale, Hôtel Dieu, Université de NantesDirection de la recherche, Plateforme de Méthodologie et Biostatistique, CHU de NantesCHU Nantes, Pôle Anesthésie-Réanimation, Service d’Anesthésie Réanimation Chirurgicale, Hôtel Dieu, Université de NantesMédecine Intensive et Réanimation, Hôtel Dieu, University Hospital of NantesAbstract Background Fluid overload has been associated with increased morbidity and mortality in critically ill patients. The goal of this study was to assess the efficacy and safety of a diuretic strategy to overcome positive fluid balance in patients on invasive mechanical ventilation. Methods Design: Multicenter, single-blind, randomized-controlled study. Patients were randomized into a diuretic (furosemide) or a control group. Patients were eligible in case of fluid overload defined as in-ICU weight increase ≥ 3%, invasive mechanical ventilation (FiO2 ≤ 60% and PEEP ≤ 10 cm H2O on inclusion) and hemodynamic stabilization. The primary outcome was fluid balance, defined as weight variation from reference weight to successful extubation. The main secondary outcome was the safety of diuretic. Results 171 patients were randomized. After 5 exclusions, 166 patients were included in the analysis: 77 in the diuretic and 89 in the control group. Fluid balance was 1.4 [− 2.5 to 4.5] kg in the diuretic and 6.4 [0.5–11.2] kg in the control group (p < 0.001). In the multiple imputation analysis, fluid balance was significantly decreased in the diuretic group (mean difference = − 4.8 95% CI [− 7.3 to − 2.5], p < 0.001). Eleven (14%) patients died in the diuretic group and 16 (18%) patients in the control group (p = 0.5). There was a worsening of Acute Kidney Injury in 67 (75.3%) patients of the control group versus 46 (59.7%) patients in the diuretic group (p = 0.03). Conclusions In this multicenter randomized-controlled study, protocolized diuretic therapy reduced fluid accumulation in patients receiving mechanical ventilation and was well tolerated with a favorable safety profile. Trial registration NCT 02345681, Registered January 26 2015, Prospectively registered, https://clinicaltrials.gov/ct2/show/NCT02345681?term=02345681&draw=2&rank=1 .https://doi.org/10.1186/s13054-021-03509-5Fluid balanceDiureticMechanical ventilationWeaning |
| spellingShingle | Raphaël Cinotti Jean-Baptiste Lascarrou Marie-Ange Azais Gwenhaël Colin Jean-Pierre Quenot Pierre-Joachim Mahé Antoine Roquilly Aurélie Gaultier Karim Asehnoune Jean Reignier Diuretics decrease fluid balance in patients on invasive mechanical ventilation: the randomized-controlled single blind, IRIHS study Critical Care Fluid balance Diuretic Mechanical ventilation Weaning |
| title | Diuretics decrease fluid balance in patients on invasive mechanical ventilation: the randomized-controlled single blind, IRIHS study |
| title_full | Diuretics decrease fluid balance in patients on invasive mechanical ventilation: the randomized-controlled single blind, IRIHS study |
| title_fullStr | Diuretics decrease fluid balance in patients on invasive mechanical ventilation: the randomized-controlled single blind, IRIHS study |
| title_full_unstemmed | Diuretics decrease fluid balance in patients on invasive mechanical ventilation: the randomized-controlled single blind, IRIHS study |
| title_short | Diuretics decrease fluid balance in patients on invasive mechanical ventilation: the randomized-controlled single blind, IRIHS study |
| title_sort | diuretics decrease fluid balance in patients on invasive mechanical ventilation the randomized controlled single blind irihs study |
| topic | Fluid balance Diuretic Mechanical ventilation Weaning |
| url | https://doi.org/10.1186/s13054-021-03509-5 |
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