The use of furosemide in critically ill patients

Abstract

Critically ill patients are those with life threatening illness who, without adequate medical interventions, will suffer from severe morbidity and occasionally mortality. One of the most frequent cause of morbidity and mortality in critically ill patients is distributive or vasogenic shock. After liberal fluid resuscitation, an increase in microvascular hydrostatic pressure, fluid accumulation of interstitial compartment, and impaired organ function occur. Normally this phase, called ebb phase, will return to flow phase where inflammatory mediators homeostasis occurs, plasma oncotic pressure restored, diuresis, extravascular fluid mobilized and negative fluid balance occur. In certain group of patients, there is persistent systemic inflammation, plasma leakage, and failure to achieve flow phase spontaneously, which lead to fluid overload and global increased permeability syndrome (GIPS). GIPS causes venous resistance of organs within compartment, resulting in decreased perfusion pressure and organ failure. In this condition, it is necessary to remove the fluid actively and one of the drugs that can be used is furosemide. This literature review will describe what happens in critically ill patients, how furosemide works, what its benefits are in critically ill patients, what side effects and potential toxicities of furosemide.