Intravenous loop diuretics are a cornerstone of therapy in acutely decompensated heart failure (ADHF). We sought to determine if there are any differences in clinical outcomes between intravenous bolus and continuous infusion of loop diuretics in ICU.

Subjects with ADHF within 12 hours of hospital admission were randomly assigned to continuous infusion or twice daily bolus therapy with furosemide. There were three co-primary endpoints assessed from admission to discharge: changes in serum creatinine, glomerular filtration rate (GFR), and reduction in B-type natriuretic peptide (BNP).

A total of 33 patients received a continuous infusion and 33 were assigned to bolus treatment. At discharge, the mean change in serum creatinine was higher (+0.9 ± 0.4 versus -0.7± 0.3 mg/dl, P <0.01), and GFR lower (-10 ± 7 versus +5 ± 6 mL/min/1.73 m2, P <0.05) in the continuous infusion arm. However, the mean reduction in BNP concentration from baseline to discharge was significantly greater with the continuous infusion compared to the bolus infusion (+0. 9± 0.4 versus -0.7± 0.3 mg/dl P <0.01). There was no significant difference in the degree of weight loss (-4.1 ± 1.9 versus -3.5 ± 2.4 kg P = 0.23). The rates of AKI were comparable (22% and 15% P = 0.3) between the two groups.

In the setting of ADHF, continuous infusion of loop diuretics resulted in greater reductions in BNP from admission to discharge.