Safety Of Ultra-high Dose Diuretics In Intensive Care Managementof Decompensated Heart Failure

• Published in: Journal of cardiac failure Vol. 31; no. 1; p. 236
• Main Authors: Oduah, Mary-Tiffany, Adel, Fadi, Allababidi, Adel Kabbara, Pereira, Naveen, Reddy, Yogesh
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.01.2025
• ISSN: 1071-9164
• DOI: 10.1016/j.cardfail.2024.10.142

There is limited data on optimal diuretic dosing strategies in critically ill patients with decompensated heart failure admitted for intensive care. High dose diuretics have been associated with modest creatinine changes without true renal injury. We hypothesized that compared to usual care, ultra-high dose diuretics would be safe and effective in critically ill patients with decompensated heart failure. To explore the safety of ultra-high dose diuretic strategy compared to conventional decongestion strategy for patients with heart failure exacerbation admitted to cardiac intensive care This was a retrospective study of all patients with acute decompensated heart failure requiring intensive care admission at the Mayo Clinic between 2020 and 2022 for decompensated heart failure. Study subjects were grouped into ultra-high dose diuretics (UHDD) - defined as furosemide equivalents (FE)> 240 mg/day compared to conventional diuretic dosing (<240 mg FE/day). Urine output over 72 hours after diuretic strategy initiation was the primary efficacy endpoint of the analysis. Primary safety endpoints were change in serum creatinine, electrolytes and blood pressure at 72 hours. Of 162 patients admitted over the study period to cardiac ICU with decompensated heart failure, 121 received UHDD diuretics with a median initial 24 hour dose of 960 mg [IQR 480-1920] compared to 180 mg [IQR 120-240] in the conventional arm (Table). This was associated with greater urine output and net negative fluid balance over 72 hours without electrolyte abnormalities or decline in renal function or blood pressure In patients admitted to the ICU with decompensated heart failure, use of ultra-high dose diuretics was associated with greater decongestion without concern for safety. Prospective randomized trials testing upfront ultrahigh dose diuretics decompensated heart failure patients are needed to validate these findings.