In this episode I’ll discuss a pilot study of protocolized diuresis for deresusciation of septic patients.
Deresuscitation is a term I expect to read much more about in literature in the near future.
It refers to the practice of correcting the fluid balance of patients who have just been fluid-resuscitated. The goal is to avoid mortality and morbidity that is believed to be associated with excess fluid balance.
In a recent pilot study published in the open-access journal Critical Care, 91 deresuscitation protocol patients were matched 1:3 with 273 standard of care patients. The diuretic dose in this study was selected based on patient renal function and history of response to diuretic therapy.
If 200 mg furosemide was exceeded and the patient still had a positive fluid balance, a thiazide diuretic was added for combination therapy.
If there was a lack of response to bolus doses of furosemide, continuous infusions of furosemide were used.
Protocolized diuresis was associated with a significant decrease in 72-hour post-shock cumulative fluid balance and an increase in the rate of ICU free days.
In addition, mortality was just 5.5% with protocolized diuresis compared to 16.1% in the standard of care group. This difference was statistically significant.
As expected, the treatment group had increased rates of hypernatremia and hypokalemia.
This pilot study provides an early look at a potentially effective deresuscication protocol and seems to suggest that the practice is likely safe other than the expected electrolyte disturbances associated with diuretic use.
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