Document Type : Original Article
Authors
Department of Anesthesiology, Isfahan University of Medical Sciences, School of Medicine, Isfahan, Iran
Abstract
Background: Pleural effusion (PE) is common in children with acute illness that are admitted to the intensive care unit (ICU). The present study aimed to investigate the efficacy of albumin add-on therapy to furosemide in contrast to furosemide treatment only for treating transudative PE.
Methods: The present randomized clinical trial was conducted on fifty 1-12-year-old children (under mechanical ventilation admitted at ICU randomly allocated to treatment with daily furosemide only (2 mg/kg) or albumin (1 gr/kg) add-on therapy to furosemide (2 mg/kg) for three days. The vital signs, venous blood gas, the pleural effusion volume, serum potassium level, potassium, and dopamine requirement were measured daily and compared between the groups.
Results: Comparison of the two groups showed a significant decrease in the pleural fluid volume (P<0.001), base excess (P<0.001), diastolic blood pressure (P=0.004), heart rate (P=0.009), and potassium (P=0.005) in the intervention group than the control group. The mean of dopamine and potassium doses requirement were 2.25±0.95 and 2.60±0.89 for the intervention group, and 1.00±0.00 and 2.00±1.41 for the control group, respectively. The comparison of the two groups showed an insignificant difference between them (P=0.26 for the dopamine injection and P=0.57 for the potassium prescription).
Conclusion: As the first study worldwide, considerable benefits were observed in the use of albumin and furosemide combination among PICU-admitted children under mechanical ventilation who required negative fluid balance. In addition, no hemodynamic instability or death was reported. During this short-term follow-up period, a satisfactory percentage of children were separated from the ventilator and transferred to the ward.
Keywords
- Maslove DM, Chen BT, Wang H, Kuschner WG. The diagnosis and management of pleural effusions in the ICU. J Intensive Care Med. 2013; 28(1):24-36. doi: 10.1177/0885066611403264.
- Mattison LE, Coppage L, Alderman DF, Herlong JO, Sahn SA. Pleural effusions in the medical ICU: prevalence, causes, and clinical implications. 1997; 111(4):1018-23. doi: 10.1378/chest.
111.4.1018. - Goligher EC, Leis JA, Fowler RA, Pinto R, Adhikari NK, Ferguson ND. Utility and safety of draining pleural effusions in mechanically ventilated patients: a systematic review and meta-analysis. Crit Care. 2011; 15(1):46. doi: 10.1186/cc10009. Epub 2011Feb2.
- Das I, Misra S, Kumar Jana P, Kumar Sinha M. A study of etiology, clinical profile and outcome of pleural effusion in children in a tertiary care hospital in eastern India. Aripex-Indian Journal of Research. 2017; 6(4):62-65.
- Fartoukh M, Azoulay E, Galliot R, Le Gall J-R, Baud F, Chevret S, et al. Clinically documented pleural effusions in medical ICU patients: how useful is routine thoracentesis? Chest. 2002; 121(1):178-84. doi: 10.1378/chest.121.1.178.
- Trotman-Dickenson B. Radiology in the intensive care unit (part 2). J Intensive Care Med. 2003; 18(5):239-52. doi: 10.1177/0885066603254087.
- Wang LM, Cherng JM, Wang JS. Improved lung function after thoracocentesis in patients with paradoxical movement of a hemidiaphragm secondary to a large pleural effusion. Respirology. 2007; 12(5):719-23. doi: 10.1111/j.1440-1843.
01124.x. - Etrugno L, Bignami E, Orso D, Vargas M, Guadagnin GM, Saglietti F, et al. Utility of pleural effusion drainage in the ICU: An updated systematic review and META-analysis. J Crit Care. 2019; 52:22-32. doi: 10.1016/j.jcrc.2019.
007. - Ferreiro L, Toubes ME, Valdes L. Contribucion del analisis del líquido pleural al diagnóstico de los derrames pleurales [Contribution of pleural fluid analysis to the diagnosis of pleural effusion]. Med Clin (Barc). 2015; 145(4):171-7. Spanish. doi: 10.1016/j.medcli.2014.08.005.
- Graf J. Pleural effusion in the mechanically ventilated patient. Curr Opin Crit Care. 2009; 15(1):10-7. doi: 10.1097/MCC.0b013e3283220e4a.
- Dres M, Razazi K. Prevalence and impact on mechanical ventilation weaning of pleural effusion in ICU patients. Clin Pulm Med. 2019; 26(5):137-40. doi: 10.1097/CPM.0000000000000324.
- National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D, et al. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006; 354(24):2564-75. doi: 10.1056/NEJMoa062200.
- Kulkarni M, Slain KN, Rotta AT, Shein SL. The effects of furosemide on oxygenation in mechanically ventilated children with bronchiolitis. J Pediatr Intensive Care. 2020; 9(2):87-91. doi: 10.1055/s-0039-3400467.
- Inoue M, Okajima K, Itoh K, Ando Y, Watanabe N, Yasaka T, Nagase S, Morino Y. Mechanism of furosemide resistance in analbuminemic rats and hypoalbuminemic patients. Kidney Int. 1987; 32(2):198-203. doi: 10.1038/ki.1987.192.
- Fliser D, Zurbrüggen I, Mutschler E, Bischoff I, Nussberger J, Franek E, Ritz E. Coadministration of albumin and furosemide in patients with the nephrotic syndrome. Kidney Int. 1999; 55(2): 629-34.
doi: 10.1046/j.1523-1755.1999.00298.x. - Elwell RJ, Spencer AP, Eisele G. Combined furosemide and human albumin treatment for diuretic-resistant edema. Ann Pharmacother. 2003; 37(5):695-700. doi: 10.1345/aph.1C320.
- Phillips M, Thomas D, Bolduc C, Arreymbi T, Rubal B, Slim A. Does albumin infusion improve loop diuretic efficacy and reduce third spacing in patients treated for acute heart failure? case series and literature review. Austin J Cardiovasc Dis Atherosclerosis. 2014; 1(1):2.
- Doungngern T, Huckleberry Y, Bloom JW, Erstad B. Effect of albumin on diuretic response to furosemide in patients with hypoalbuminemia. Am J Crit Care. 2012; 21(4):280-6. doi: 10.4037/ajcc2012999.
- Reddy KR, Basavaraja GV, Shivananda. Furosemide infusion in children with dengue fever and hypoxemia. Indian Pediatr. 2014; 51(4):303-5. doi: 10.1007/s13312-014-0398-8.
- Reddy M, Nallasamy K, Muralidharan J, Bansal A. Abstract O-46: Albumin and furosemide for diuresis in critically ill children with fluid overload-a pilot randomized double blind placebo-controlled trial. Pediatric Critical Care Medicine. 2018; 19:20. doi:1097/01.pcc.0000537388.45698.4b.
)