(1570) Evaluation of Diuretic Use and Impact on Respiratory Outcomes in Critically Ill Trauma Patients

Introduction: Positive fluid balance after fluid resuscitation has been associated with negative outcomes, including prolonged mechanical ventilation. Critically ill trauma patients often experience fluctuations in clinical status and are particularly vulnerable to the risks of fluid accumulation. While many clinicians provide diuretic therapy to facilitate deresuscitation, the respiratory benefit of this practice is unclear. The purpose of this evaluation was to assess improvement of oxygenation as a response to diuretic therapy in mechanically ventilated trauma patients.

Methods: This retrospective cohort study evaluated trauma patients on mechanical ventilation who received loop diuretics and had a positive cumulative fluid balance. The primary objective was to identify overall rate of response and potential predictors of response to diuretic therapy. Response to therapy was defined as an increase in PaO2:FiO2 ratio by >20% or liberation from mechanical ventilation within 6-24 hours of diuretic dose.

Results: Of 252 patients who were screened, 71 met criteria for evaluation. Of 71 intubated trauma patients who received a loop diuretic, 26 (37%) achieved a clinical respiratory response within 24 hours. Patients in the cohort received a median dose of 20 mg of furosemide [IQR 20-40 mg] at a median of 4 days from ICU admission [IQR 3-7 days]. The most common mechanism of injury was blunt trauma (74.6%), and the median injury severity score was 29.0. Patients who achieved respiratory response to diuretic therapy tended to be younger, have a penetrating injury, and have a greater net positive fluid balance prior to diuretic administration; however, these did not reach statistical significance. Responders had a numerically shorter duration of mechanical ventilation post-diuresis, shorter ICU LOS, and lower ICU mortality. Safety event outcomes were rare in the entire cohort.

Conclusions: Our results demonstrate deresuscitation with loop diuretics in critically ill trauma patients is a safe intervention that may provide a respiratory benefit in volume overloaded patients. To confirm our findings, larger trials are needed to expand upon clinical benefits of deresuscitation practices, optimize agent selection and dosing regimens, and establish diuresis titration parameters in critically ill trauma patients.