Diuretics decrease fluid balance in patients on invasive mechanical ventilation: the randomized-controlled single blind, IRIHS study

Raphaël Cinotti, Jean-Baptiste Lascarrou, Marie-Ange Azais, Gwenhaël Colin, Jean-Pierre Quenot, Pierre-Joachim Mahé, Antoine Roquilly, Aurélie Gaultier, Karim Asehnoune, Jean Reignier, Raphaël Cinotti, Jean-Baptiste Lascarrou, Marie-Ange Azais, Gwenhaël Colin, Jean-Pierre Quenot, Pierre-Joachim Mahé, Antoine Roquilly, Aurélie Gaultier, Karim Asehnoune, Jean Reignier

Abstract

Background: Fluid overload has been associated with increased morbidity and mortality in critically ill patients. The goal of this study was to assess the efficacy and safety of a diuretic strategy to overcome positive fluid balance in patients on invasive mechanical ventilation.

Methods: Design: Multicenter, single-blind, randomized-controlled study. Patients were randomized into a diuretic (furosemide) or a control group. Patients were eligible in case of fluid overload defined as in-ICU weight increase ≥ 3%, invasive mechanical ventilation (FiO2 ≤ 60% and PEEP ≤ 10 cm H2O on inclusion) and hemodynamic stabilization. The primary outcome was fluid balance, defined as weight variation from reference weight to successful extubation. The main secondary outcome was the safety of diuretic.

Results: 171 patients were randomized. After 5 exclusions, 166 patients were included in the analysis: 77 in the diuretic and 89 in the control group. Fluid balance was 1.4 [- 2.5 to 4.5] kg in the diuretic and 6.4 [0.5-11.2] kg in the control group (p < 0.001). In the multiple imputation analysis, fluid balance was significantly decreased in the diuretic group (mean difference = - 4.8 95% CI [- 7.3 to - 2.5], p < 0.001). Eleven (14%) patients died in the diuretic group and 16 (18%) patients in the control group (p = 0.5). There was a worsening of Acute Kidney Injury in 67 (75.3%) patients of the control group versus 46 (59.7%) patients in the diuretic group (p = 0.03).

Conclusions: In this multicenter randomized-controlled study, protocolized diuretic therapy reduced fluid accumulation in patients receiving mechanical ventilation and was well tolerated with a favorable safety profile. Trial registration NCT02345681, Registered January 26 2015, Prospectively registered, https://ichgcp.net/clinical-trials-registry/NCT02345681?term=02345681&draw=2&rank=1 .

Keywords: Diuretic; Fluid balance; Mechanical ventilation; Weaning.

Conflict of interest statement

Pr Karim Asehnoune received fees from Baxter, Edwards, LFB, Fisher and Payckel. Pr Roquilly received fees from MSD and Biomérieux. Dr Raphaël Cinotti received fees from Paion. The authors do not declare any conflict of interest about this study.

Figures

Fig. 1
Fig. 1
Study flowchart
Fig. 2
Fig. 2
Design and main result

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