UMEM Educational Pearls

Category: Critical Care

Title: Simultaneous Use of Hypertonic Saline and IV Furosemide for Fluid Overload: A Systematic Review and Meta-Analysis

Keywords: decompensated heart failure, hypertonic saline, furosemide (PubMed Search)

Posted: 10/19/2021 by Quincy Tran, MD (Updated: 12/3/2022)
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Settings & Designs: a meta-analysis of 11 randomized controlled trials among patients with fluid overload.

Patients: This meta-analysis included 2987 patients with acute decompensated heart failure.

Intervention: intravenous hypertonic saline + intravenous furosemide.

Comparison: intravenous furosemide

Outcome: all-cause mortality, hospital length of stay

Study Results:

·       Hypertonic saline + furosemide treatment was associated with lower relative risk of mortality (RR 0.55, 95% CI 0.33-0.76%, P< 0.05, I-square = 12%).

·       Hypertonic saline + furosemide treatment was also associated with 3.8 shorter hospital length of stay (mean difference = -3.38 days, 95% CI -4.1 to -2.4, P< 0.05, I-square = 93%). 

·       Sodium creatine also decreased about 0.46 mg/dl (mean difference, -0.46, 95% CI -051, -0.41, P<0.05, I-square 89%) for patients received both hypertonic saline and furosemide.

Discussion:

·       Most studies only included patients with advanced heart failure (NYHA class IV, EF < 35%)

·       For these patients with advanced heart failure, most studies infused 150 ml of 1.5%-3% saline.  However, all studies used very high doses of furosemide (500mg -1000mg BID).

Conclusion:

In patients with acute decompensated heart failure, a combination of hypertonic saline and intravenous furosemide was associated with improved outcomes, compared with a single therapy of furosemide.

 

References

Liu, Chang PhD, MD; Peng, Zhiyong PhD, MD; Gao, Xiaolan MD; Gajic, Ognjen MD; Dong, Yue MD; Prokop, Larry J. MLS; Murad, M. Hassan MD; Kashani, Kianoush B. MD, MSc, FASN, FCCP; Domecq, Juan Pablo MD. Simultaneous Use of Hypertonic Saline and IV Furosemide for Fluid Overload: A Systematic Review and Meta-Analysis, Critical Care Medicine: November 2021 - Volume 49 - Issue 11 - p e1163-e1175 doi: 10.1097/CCM.0000000000005174.