重症患者服用呋塞米和辅助乙酰唑胺与仅服用呋塞米相比：双中心随机对照试验。

IF 3.2 3区医学 Q2 CRITICAL CARE MEDICINE

Journal of critical care Pub Date : 2024-12-16 DOI:10.1016/j.jcrc.2024.155002

Akinori Maeda , Alastair Brown , Sofia Spano , Anis Chaba , Atthaphong Phongphithakchai , Yukiko Hikasa , Nuttapol Pattamin , Nuanprae Kitisin , Jonathan Nübel , Bethany Nielsen , Jennifer Holmes , Leah Peck , Helen Young , Glenn Eastwood , Rinaldo Bellomo , Ary Serpa Neto

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引用次数: 0

摘要

目的：速尿是重症监护病房（ICU）最常用的利尿剂。本研究旨在评价乙酰唑胺联合呋塞米对利尿的生理作用及预防呋塞米可能引起的代谢性碱中毒。材料和方法：我们进行了一项双中心、先导、开放标签、随机试验。在治疗医生计划静脉利尿剂治疗的情况下，我们将ICU患者随机分为两组：速尿（40mg）加乙酰唑胺（500mg）（n = 15）或速尿单独（40mg）（n = 15）。根据贝叶斯框架比较尿量、额外使用速尿、酸碱参数和电解质。结果：辅助乙酰唑胺在前6小时内未增加尿量（平均差值：-112 ml，可信间隔：[- 742,514]）。然而，与单独使用呋塞米相比，在24小时内，它对呋塞米保持更大的尿输出反应，概率为100%。乙酰唑胺还能使血浆酸化（pH值差：-0.045,[-0.081,-0.008]），同时在6小时内使尿液碱化（pH值差为1.10,[0.04,2.11]），与呋塞米单独使用相比，概率为95%。最后，我们在24小时内未观察到严重的酸中毒或电解质紊乱。结论：辅助乙酰唑胺可以增加利尿功效，抵消呋塞米引起的代谢性碱中毒，而不存在安全性问题。需要更大规模的试验来验证这些发现并评估其对临床结果的影响。注册号：ACTRN12623000624684。注册标题：重症监护病房单一与双重利尿剂治疗的试点试验。

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Furosemide with adjunctive acetazolamide vs furosemide only in critically ill patients: A pilot two-center randomized controlled trial

Purpose

Furosemide is the most commonly used diuretic in intensive care units (ICU). We aimed to evaluate the physiological effects of adjunctive acetazolamide with furosemide on diuresis and the prevention of potential furosemide-induced metabolic alkalosis.

Materials and methods

We performed a two-center, pilot, open-label, randomized trial. Where the treating physicians planned intravenous diuretic therapy, we randomized ICU patients to a bolus of furosemide (40 mg) plus acetazolamide (500 mg) (n = 15) or furosemide alone (40 mg) (n = 15). Urine output, additional furosemide use, acid-base parameters, and electrolytes were compared following a Bayesian framework.

Results

Adjunctive acetazolamide didn't increase urine output in the first six hours (mean difference: −112 ml, credible interval: [−742, 514]). However, compared with furosemide alone, it maintained a greater urine output response to furosemide over 24 h, with 100 % probability. Acetazolamide also acidified plasma (pH difference: −0.045, [−0.081, −0.008]) while alkalinizing urine (1.10, [0.04, 2.11]) at six hours, compared to furosemide alone with >95 % probability. Finally, we didn't observe severe acidosis or electrolyte disturbances over 24 h.

Conclusions

Adjunctive acetazolamide may increase diuretic efficacy and counterbalance furosemide-induced metabolic alkalosis without safety concerns. Larger trials are warranted to verify these findings and assess their impacts on clinical outcomes.

Registration number

ACTRN12623000624684.

Registration title

A pilot trial of single versus dual diuretic therapy in the intensive care unit.

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来源期刊

Journal of critical care 医学-危重病医学

CiteScore

8.60

自引率

2.70%

发文量

237

审稿时长

23 days

期刊介绍： The Journal of Critical Care, the official publication of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM), is a leading international, peer-reviewed journal providing original research, review articles, tutorials, and invited articles for physicians and allied health professionals involved in treating the critically ill. The Journal aims to improve patient care by furthering understanding of health systems research and its integration into clinical practice. The Journal will include articles which discuss: All aspects of health services research in critical care System based practice in anesthesiology, perioperative and critical care medicine The interface between anesthesiology, critical care medicine and pain Integrating intraoperative management in preparation for postoperative critical care management and recovery Optimizing patient management, i.e., exploring the interface between evidence-based principles or clinical insight into management and care of complex patients The team approach in the OR and ICU System-based research Medical ethics Technology in medicine Seminars discussing current, state of the art, and sometimes controversial topics in anesthesiology, critical care medicine, and professional education Residency Education.