{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T18:33:22Z","timestamp":1793385202265,"version":"4.5.0"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2014,6,28]],"date-time":"2014-06-28T00:00:00Z","timestamp":1403913600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2014,6,28]],"date-time":"2014-06-28T00:00:00Z","timestamp":1403913600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Crit Care"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Intravenous loop diuretics are a cornerstone of therapy in acutely decompensated heart failure (ADHF). We sought to determine if there are any differences in clinical outcomes between intravenous bolus and continuous infusion of loop diuretics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Subjects with ADHF within 12\u00a0hours of hospital admission were randomly assigned to continuous infusion or twice daily bolus therapy with furosemide. There were three co-primary endpoints assessed from admission to discharge: the mean paired changes in serum creatinine, estimated glomerular filtration rate (eGFR), and reduction in B-type natriuretic peptide (BNP). Secondary endpoints included the rate of acute kidney injury (AKI), change in body weight and six months follow-up evaluation after discharge.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 43 received a continuous infusion and 39 were assigned to bolus treatment. At discharge, the mean change in serum creatinine was higher (+0.8\u2009\u00b1\u20090.4 versus -0.8\u2009\u00b1\u20090.3\u00a0mg\/dl\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.01), and eGFR was lower (-9\u2009\u00b1\u20097 versus +5\u2009\u00b1\u20096\u00a0ml\/min\/1.73\u00a0m\n                      <jats:sup>2<\/jats:sup>\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.05) in the continuous arm. There was no significant difference in the degree of weight loss (-4.1\u2009\u00b1\u20091.9 versus -3.5\u2009\u00b1\u20092.4\u00a0kg\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.23). The continuous infusion arm had a greater reduction in BNP over the hospital course, (-576\u2009\u00b1\u2009655 versus -181\u2009\u00b1\u2009527\u00a0pg\/ml\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.02). The rates of AKI were comparable (22% and 15%\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.3) between the two groups. There was more frequent use of hypertonic saline solutions for hyponatremia (33% versus 18%\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.01), intravenous dopamine infusions (35% versus 23%\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.02), and the hospital length of stay was longer in the continuous infusion group (14. 3\u2009\u00b1\u20095 versus 11.5\u2009\u00b1\u20094\u00a0days,\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.03). At 6\u00a0months there were higher rates of re-admission or death in the continuous infusion group, 58% versus 23%, (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.001) and this mode of treatment independently associated with this outcome after adjusting for baseline and intermediate variables (adjusted hazard ratio\u2009=\u20092.57, 95% confidence interval, 1.01 to 6.58\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.04).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In the setting of ADHF, continuous infusion of loop diuretics resulted in greater reductions in BNP from admission to discharge. However, this appeared to occur at the consequence of worsened renal filtration function, use of additional treatment, and higher rates of rehospitalization or death at six months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>ClinicalTrials.govNCT01441245. Registered 23 September 2011.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/cc13952","type":"journal-article","created":{"date-parts":[[2014,6,28]],"date-time":"2014-06-28T05:27:47Z","timestamp":1403933267000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":66,"title":["Continuous versus bolus intermittent loop diuretic infusion in acutely decompensated heart failure: a prospective randomized trial"],"prefix":"10.1186","volume":"18","author":[{"given":"Alberto","family":"Palazzuoli","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Pellegrini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaetano","family":"Ruocco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Martini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice","family":"Franci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Stella","family":"Campagna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marilyn","family":"Gilleman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ranuccio","family":"Nuti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter A","family":"McCullough","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio","family":"Ronco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2014,6,28]]},"reference":[{"key":"2585_CR1","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1161\/CIRCHEARTFAILURE.108.821785","volume":"2","author":"GM Felker","year":"2009","unstructured":"Felker GM, O'Connor CM, Braunwald E: Loop diuretics in acute decompensated heart failure: necessary? 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