• Nutnicha Preeprem, Emily See, Siva P Namachivayam, and Ben Gelbart.
• Pediatric Intensive Care Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
• Crit Care Resusc. 2024 Dec 1; 26 (4): 319325319-325.

ObjectiveFrusemide is a common diuretic administered to critically ill children intravenously, by either continuous infusion (CI) or intermittent bolus (IB). We aim to describe the characteristics of children who receive intravenous frusemide, patterns of use, and incidence of acute kidney injury (AKI), and to investigate factors associated with commencing CI.DesignRetrospective observational study.SettingPaediatric intensive care unit (PICU), the Royal Children's Hospital Melbourne.ParticipantsChildren who received intravenous frusemide during PICU admission lasting ≥24 h between 2017 and 2022.Main Outcome MeasuresThe primary outcome was the daily dose of frusemide. Secondary outcomes included timing of therapy from PICU admission, fluid balance at frusemide initiation, additional diuretic therapy, and the incidence of AKI at admission and frusemide initiation. Children who received CI were compared with those who received IB only using multivariable logistic regression analyses.ResultsNine thousand three ninety-four children were admitted during the study period. A total of 1387 children (15 %) received intravenous frusemide, including 220 children (16 %) by CI. The CI group were younger (132 vs 202 days, p = 0.01), had higher PIM-3 scores (2.2 vs 1.5, p-value <0.001), more congenital heart disease (CHD) (72.3 % vs 60.6 %, p <0.01), and higher incidence and severity of AKI at frusemide initiation than the IB group (65.7 % vs 40.1 %, p-value <0.001). CI were commenced later than IB (46 vs 19 h into admission, p <0.001) and at higher doses (4.3 vs 1.5 mg/kg/day, p-value <0.001). In multivariable analyses, CHD (aOR 1.67, 95 % CI 1.16-2.40, p <0.01) was associated with CI.ConclusionFrusemide infusions are administered more commonly to children with CHD, later in PICU admission, and at higher daily doses compared to IB. Children who receive CI have a higher incidence and severity of AKI at initiation.© 2024 The Authors.

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