Treating acute pulmonary oedema and acute decompensated heart failure in the emergency department with intravenous furosemide: A systematic review of adult patient outcomes

Background: Furosemide is a loop diuretic commonly used in the treatment of acute pulmonary oedema in an Australian context. The drug facilitates diuresis, providing a means for offloading the fluid congestion synonymous with acute pulmonary oedema. However, whilst recognised as beneficial in this respect, it has been postulated that furosemide therapy may contribute to poor patient outcomes.

Aim: To appraise existing literature on the use of furosemide in adult patients presenting to the ED with acute pulmonary oedema and acute decompensated heart failure.

Method: Ten databases were searched for published and unpublished literature. Retrieved records were screened for eligibility against set inclusion criteria and appraised for methodological quality.

Results: Three randomised controlled trials and one cohort study were eligible for inclusion. Furosemide was shown not to provide any statistically significant improvements in respiratory distress, pH, blood pressure or oxygen saturation. Furosemide therapy was shown to cause significant depletions in serum potassium when delivered as continuous infusion

Conclusion: There is little compelling evidence, as supported by a lack of statistically significant results to show that furosemide contributes to poor or beneficial patient outcomes. Findings did not highlight any statistically significant advantages of the medication, however results were still clinically important. Furosemide was shown to cause hypokalaemia when delivered as a high dose continuous infusion and also provided some relief from short-term dyspnoea. Inconsistent dosing, inclusion criteria, routes of administration and methods of measuring outcomes were noted across the studies, which created difficulty when comparing results directly with one another. Additionally, it was unclear whether all participants in the included studies received non-invasive positive pressure ventilation and nitrate medication as a component of their therapy.