Single Dose of Furosemide to Improve Respiratory Distress in Moderate to Severe Bronchiolitis

Summary

The purpose of this study is to assess if administration of an early single dose of a diuretic (furosemide) to children with moderate to severe bronchiolitis can reduce extravascular lung water in an effort to reduce respiratory rate, retractions, intubations, and length of stay.

Timeline

Start

2013-10

Primary completion

2016-04

Completion

2016-04

Outcome

Missed primary endpoint

paper There was no difference in respiratory rates, measured as a decrease of ≥ 25%, at both 2 and 4 h after intervention between furosemide and placebo groups PMID 29174754 ↗

Publications

• Background Pelletier AJ, Mansbach JM, Camargo CA Jr. Direct medical costs of bronchiolitis hospitalizations in the United States. Pediatrics. 2006 Dec;118(6):2418-23. doi: 10.1542/peds.2006-1193.
• Background Baker MD. Pitfalls in the use of clinical asthma scoring. Am J Dis Child. 1988 Feb;142(2):183-5. doi: 10.1001/archpedi.1988.02150020085035.
• Background Farias JA, Fernandez A, Monteverde E, Flores JC, Baltodano A, Menchaca A, Poterala R, Panico F, Johnson M, von Dessauer B, Donoso A, Zavala I, Zavala C, Troster E, Pena Y, Flamenco C, Almeida H, Nilda V, Esteban A; Latin-American Group for Mechanical Ventilation in Children. Mechanical ventilation in pediatric intensive care units during the season for acute lower respiratory infection: a multicenter study. Pediatr Crit Care Med. 2012 Mar;13(2):158-64. doi: 10.1097/PCC.0b013e3182257b82.
• Background Hernando Puente M, Lopez-Herce Cid J, Bellon Cano JM, Villaescusa JU, Santiago Lozano MJ, Sanchez Galindo A. [Prognostic factors for bronchiolitis complications in a pediatric intensive care unit]. An Pediatr (Barc). 2009 Jan;70(1):27-33. doi: 10.1016/j.anpedi.2008.08.004. Epub 2008 Nov 25. Spanish.
• Background National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network; Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D, deBoisblanc B, Connors AF Jr, Hite RD, Harabin AL. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006 Jun 15;354(24):2564-75. doi: 10.1056/NEJMoa062200. Epub 2006 May 21.
• Background Rush MG, Engelhardt B, Parker RA, Hazinski TA. Double-blind, placebo-controlled trial of alternate-day furosemide therapy in infants with chronic bronchopulmonary dysplasia. J Pediatr. 1990 Jul;117(1 Pt 1):112-8. doi: 10.1016/s0022-3476(05)82458-8.
• Background Stewart A, Brion LP. Intravenous or enteral loop diuretics for preterm infants with (or developing) chronic lung disease. Cochrane Database Syst Rev. 2011 Sep 7;2011(9):CD001453. doi: 10.1002/14651858.CD001453.pub2.
• Background Hagadorn JI, Sanders MR, Staves C, Herson VC, Daigle K. Diuretics for very low birth weight infants in the first 28 days: a survey of the U.S. neonatologists. J Perinatol. 2011 Oct;31(10):677-81. doi: 10.1038/jp.2011.11. Epub 2011 Mar 10.
• Background Green TP. The pharmacologic basis of diuretic therapy in the newborn. Clin Perinatol. 1987 Dec;14(4):951-64.
• Background Hufnagle KG, Khan SN, Penn D, Cacciarelli A, Williams P. Renal calcifications: a complication of long-term furosemide therapy in preterm infants. Pediatrics. 1982 Sep;70(3):360-3.
• Background Ross BS, Pollak A, Oh W. The pharmacologic effects of furosemide therapy in the low-birth-weight infant. J Pediatr. 1978 Jan;92(1):149-52. doi: 10.1016/s0022-3476(78)80098-5.
• Background Ghanekar AG, Das Gupta V, Gibbs CW Jr. Stability of furosemide in aqueous systems. J Pharm Sci. 1978 Jun;67(6):808-11. doi: 10.1002/jps.2600670621.
• Williamson K, Bredin G, Avarello J, Gangadharan S. A Randomized Controlled Trial of a Single Dose Furosemide to Improve Respiratory Distress in Moderate to Severe Bronchiolitis. J Emerg Med. 2018 Jan;54(1):40-46. doi: 10.1016/j.jemermed.2017.08.099. Epub 2017 Nov 23.

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Indications