Diuretic combinations in critically ill patients with respiratory failure:A systematic review and meta-analysis  

作　　者：Jean Maxime Côté Nadir Goulamhoussen Blaithin A McMahon Patrick T Murray 

机构地区：[1]Division of Nephrology,Department of Medicine,Centre Hospitalier de l'Universitéde Montréal,Montréal H2X0C1,Québec,Canada [2]Division of Nephrology,Department of Medicine,Medical University of South Carolina,Charleston,SC 29425,United States [3]Department of Medicine,School of Medicine,University College Dublin,Dublin D078NN,Ireland

出　　处：《World Journal of Critical Care Medicine》2022年第3期178-191,共14页世界重症医学杂志

摘　　要：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.

关 键 词：Respiratory failure DIURETICS Fluid management FUROSEMIDE THIAZIDE Systematic review 

分 类 号：R73[医药卫生—肿瘤]