Introduction: Effective diuresis is critical in managing Pediatric Intensive Care Unit (PICU) patients. Furosemide continuous infusions (FD) often provide suboptimal results. Bumetanide continuous infusion (BD), being 40 times more potent, may be a viable alternative, but PICU data are limited. We evaluated the safety and efficacy of BD in this setting. Methods: This retrospective case-control study compared the outcomes of BD-treated patients with FD controls. Baseline characteristics and outcome variables were compared between the 2 groups. Results: From 1/1/16 to 10/31/24, 168 patients received BD and 227 patients received FD in our PICU. Fifty-nine patients didn’t respond to FD and required transition to BD. Of 59 patients, BD achieved diuresis goals and success in hospital discharge in 51 patients. Eight patients required continuous renal replacement therapy (CRRT), Extra-Corporeal Membrane Oxygenation (ECMO), transfer to a higher center, or died. We then studied the subset of BD and FD groups with 50 patients in each. BD was dosed at 0.05-16 mcg/kg/hour (mean 9.6, median 10, max 10 mg/day) over 2-27 days (mean 8.68). FD was dosed at 0.05-0.38 mg/kg/hour (mean 0.2, median 0.18) for 1-30 (4.71) days. BD group had lower mean hemoglobin (p< 0.05). The other baseline characteristics of both groups were similar by demographics, acuity, diagnosis, and severity scores. Hospital and PICU length of stay (p< 0.001) and ventilator days (p=0.004) were higher in the BD group. Twenty-two patients in this group received FD before BD, for a mean duration of 3.6 (0.25-19) days. The other outcome variables, including mortality, fluid and urine balance, need for high-frequency oscillator, inotropes, CRRT, or ECMO, did not differ between groups. The number of concurrent diuretics, and the adverse reactions of electrolyte imbalance and renal dysfunction did not differ between the groups. Conclusions: BD was well tolerated with FD-comparable adverse effects. Longer length of stay and ventilator dependence in the BD group were plausibly related to initial FD failure, yet BD achieved target diuresis eventually. These findings support BD as a safe alternative, with potential utility as a first-line diuretic in select PICU populations. This study also delineates effective dosing ranges and treatment durations for both agents.
Mohammed et al. (Sun,) studied this question.