Intravenous Chlorothiazide Versus Enteral Metolazone to Augment Loop Diuretic Therapy in the Intensive Care Unit
| Autor: | Kendall C. Mintus, Christopher J. Michaud |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.drug_class Critical Illness Administration Oral 030204 cardiovascular system & hematology Enteral administration law.invention 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Sodium Potassium Chloride Symporter Inhibitors law Furosemide Metolazone medicine Humans Pharmacology (medical) 030212 general & internal medicine Thiazide Retrospective Studies business.industry Retrospective cohort study Loop diuretic Chlorothiazide Intensive care unit Diuresis Intensive Care Units chemistry Anesthesia Administration Intravenous Drug Therapy Combination Female business medicine.drug |
| Zdroj: | The Annals of pharmacotherapy. 51(4) |
| ISSN: | 1542-6270 |
| Popis: | Background: In cases of loop diuretic resistance in the intensive care unit (ICU), recommendations for a specific second-line thiazide agent are lacking. Objective: To compare the effects of intravenous chlorothiazide (CTZ) and enteral metolazone (MET) on urine output (UOP) when added to furosemide monotherapy therapy in critically ill adults. Methods: This was a retrospective cohort study conducted in the medical, surgical, and cardiothoracic ICUs of a quaternary medical center. The primary outcome was change in UOP induced by the study interventions compared with furosemide alone. Secondary outcomes included onset of diuresis, eventual need for hemodialysis, and incidence of adverse events. Results: A total of 122 patients (58 in CTZ, 64 in MET) were included. When added to furosemide monotherapy, CTZ induced a greater change in UOP at 24 hours compared with MET (2405 vs 1646 mL, respectively; P = 0.01). CTZ also caused a more rapid dieresis: 1463 mL total UOP in the first 6 hours compared with 796 mL in the MET group ( P < 0.01). There were no differences found regarding ICU length of stay, need for renal replacement therapy, or survival to discharge. The CTZ arm required more potassium supplementation to maintain normokalemia (median 100 vs 57 mEq in MET; P = 0.02) and carried a higher cost (mean $97 vs $8, P < 0.01). Conclusion: Both CTZ and MET induced significant increases in UOP. CTZ induced a greater and more rapid change and was associated with higher cost and greater need for potassium replacement. Randomized controlled trials are needed to establish whether a preferable thiazide diuretic exists in this setting. |
| Databáze: | OpenAIRE |
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