Diuretic combinations in critically ill patients with respiratory failure: A systematic review and meta-analysis.
World J Crit Care Med
; 11(3): 178-191, 2022 May 09.
Article
in En
| MEDLINE
| ID: mdl-36331969
ABSTRACT
BACKGROUND:
In patients with respiratory failure, loop diuretics remain the cornerstone of the treatment to maintain fluid balance, but resistance is common.AIM:
To determine the efficacy and safety of common diuretic combinations in critically ill patients with respiratory failure.METHODS:
We searched MEDLINE, Embase, Cochrane Library and PROSPERO for studies reporting the effects of a combination of a loop diuretic with another class of diuretic. A meta-analysis using mean differences (MD) with 95% confidence interval (CI) was performed for the 24-h fluid balance (primary outcome) and the 24-h urine output, while descriptive statistics were used for safety events.RESULTS:
Nine studies totalling 440 patients from a total of 6510 citations were included. When compared to loop diuretics alone, the addition of a second diuretic is associated with an improved negative fluid balance at 24 h [MD -1.06 L (95%CI -1.46; -0.65)], driven by the combination of a thiazide plus furosemide [MD -1.25 L (95%CI -1.68; -0.82)], while no difference was observed with the combination of a loop-diuretic plus acetazolamide [MD -0.40 L (95%CI -0.96; 0.16)] or spironolactone [MD -0.65 L (95%CI -1.66; 0.36)]. Heterogeneity was high and the report of clinical and safety endpoints varied across studies.CONCLUSION:
Based on limited evidence, the addition of a second diuretic to a loop diuretic may promote diuresis and negative fluid balance in patients with respiratory failure, but only when using a thiazide. Further larger trials to evaluate the safety and efficacy of such interventions in patients with respiratory failure are required.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Type of study:
Systematic_reviews
Language:
En
Journal:
World J Crit Care Med
Year:
2022
Document type:
Article
Affiliation country:
Canada