• Archit Sharma, Sarat Kuppachi, Sudhakar Subramani, Anureet Walia, Jacob Thomas, and Harish Ramakrishna.
• Division of Cardiothoracic Anesthesiology Solid Organ Transplant and Critical Care, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA.
• J. Cardiothorac. Vasc. Anesth. 2020 Aug 1; 34 (8): 2253-2259.

AbstractHEART FAILURE (HF) is one of the most common causes of hospitalization in the United States. Loop diuretics (LD) are the mainstay of treatment in the management of acute and chronic HF. Although they generally are effective in relieving symptoms and reducing congestion, LD have not been shown to significantly affect morbidity and mortality. The initial decongestion strategy for management of HF is likely to be an LD, with evidence suggesting that an initial "high-dose" strategy either by twice-daily bolus injection or by continuous infusion is likely to be more successful than an initial lower dose in respect to relief of symptoms but at the expense of increased worsening of renal function. This review focuses on the current state of evidence of different strategies related to the use of LD in the treatment of congestive symptoms in critically ill patients and presents a summary of the body of evidence regarding dosages, timing, and different diuretic agents.Copyright © 2019. Published by Elsevier Inc.

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