Hemodynamics, fluids & transfusion
Diuretics depletion improves cardiac output and ventriculo-arterial coupling in congestive ICU patients during hemodynamic de-escalation
Authors' conclusion
The initiation of diuretics in ICU congestive patients with stabilized shock was associated with improvement of cardiac index, ventriculo-arterial coupling, and tissue perfusion parameter. These effects were not observed in non-congestive patients.
Study context
- Population
- Resuscitated adults with stabilized shock and clinical signs of fluid overload starting loop diuretics, cardiovascular medico-surgical ICU
- Participants
- 70 adults
- Exposure
- Congestive vs non-congestive patients, before vs 24 h after loop diuretic initiation
- Congestiven = 51
- Outcome
- Hemodynamic effects of diuretic initiation (cardiac index)
- Follow-up
- 24 h
Methodological detailsmonocentric
- Monocentric
Main finding
As reported in the abstract
Cardiac index after vs before diuretics
| Group | Value | Baseline | P vs baseline |
|---|---|---|---|
| Congestive | mean 2.7 (SD 0.8) L min- 1 m- 2 | 2.5 ± 0.8 L min- 1 m- 2 | p = 0.042 |
| Non-congestive | mean 2.7 (SD 0.7) L min- 1 m- 2 | 2.7 ± 0.8 L min- 1 m- 2 | p = 0.968 |
Value
Congestivemean 2.7 (SD 0.8) L min- 1 m- 2
Non-congestivemean 2.7 (SD 0.7) L min- 1 m- 2
Baseline
Congestive2.5 ± 0.8 L min- 1 m- 2
Non-congestive2.7 ± 0.8 L min- 1 m- 2
P vs baseline
Congestivep = 0.042
Non-congestivep = 0.968
Observational data: associations, not effects.
Further findings
Arterial lactate, congestive
- Decrease in congestive group (2.1 ± 2 vs. 1.3 ± 0.6 mmol L- 1)
- P < 0.001
Ventriculo-arterial coupling, congestive
- Improved vs baseline in congestive group (1.69 ± 1 vs. 1.92 ± 1.5)
- P = 0.03
Norepinephrine use
- Decreased in congestive patients
- P = 0.021
- Not decreased in non-congestive group
- P = 0.467
Original publication
Diuretics depletion improves cardiac output and ventriculo-arterial coupling in congestive ICU patients during hemodynamic de-escalation. J Clin Monit Comput. Published 25 April 2023. doi:10.
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