Diuresis effectiveness of aminophylline and furosemide combination in critically ill adults / Ng Haw Shyan

Ng , Haw Shyan (2024) Diuresis effectiveness of aminophylline and furosemide combination in critically ill adults / Ng Haw Shyan. Masters thesis, Universiti Malaya.

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Abstract

Furosemide is commonly used to improve urine output; however its use is not without complications. Aminophylline, a potent bronchodilator, has also been shown to exhibit diuretic properties though its effects on renal vascular. Concurrently use of Aminophylline and Furosemide has been used clinically in adult patients undergoing cardiac surgery and in paediatric population, especially in neonates. However, evidence of Aminophylline and Furosemide combination use in critically ill adults is scarce. We conducted a randomised controlled trial in University of Malaya Medical Center intensive care unit from 1st July 2023 up to 31st March 2024, to compare the effectiveness of aminophylline and furosemide combination versus furosemide alone in producing effective diuresis. A total of 28 adult ICU patients were randomly divided into intervention group (n = 14) and control group (n = 14). The intervention group received infusion of Aminophylline 150mg and Furosemide 120mg diluted in 50ml normal saline, while control group received infusion of Furosemide 120mg diluted in 50ml normal saline. Primary outcome was diuresis effectiveness 6 hours post intervention, effective diuresis was defined as urine output > 0.5ml/kg/hr. Secondary outcomes include diuresis effectiveness 2 hours post intervention, mean duration to produce effective diuresis, mean change of urine output over 6 hours, mean change of serum creatinine level and eGFR over one day, and the need for renal replacement therapy during ICU stay. Our study revealed that intervention group was not superior to control group in producing effective diuresis within 2 hours and 6 hours period, however this finding was not statistically significant. There was no clinical difference in time taken for either group to achieve effective diuresis. Urine output over 6 hours improved more for control group. There was less increase in serum creatinine level and less reduction in eGFR in intervention compared to control group. There were more patients who had RRT during their ICU stay in control group compared to intervention group. In conclusion, the infusion of combined Aminophylline and Furosemide is not superior to Furosemide alone in producing effective diuresis. The combined infusion may have a renal protective effect, but our findings need to be confirmed by future study with larger sample size.

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