Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Pulmonary Circulation
Diuretics in Normotensive Patients With Acute Pulmonary Embolism and Right Ventricular Dilatation
Julien TernacleRomain GalletArmand Mekontso-DessapGuy MeyerBernard MaitreAlexandre BensaidPriscille JurzakPascal GueretJean-Luc Dubois RandéPascal Lim
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2013 Volume 77 Issue 10 Pages 2612-2618

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Abstract

Background: The benefit of load expansion is controversial in acute pulmonary embolism (PE). The aim of this study was to evaluate the benefit of furosemide in cases of normotensive acute PE. Methods and Results: We retrospectively included 70 consecutive normotensive patients (systolic blood pressure ≥90mmHg) admitted for acute PE with right ventricular dilation. Overall, 40 patients were treated during the first 24h by repeated bolus of furosemide (78±42mg, range 40–160mg) and 30 patients received isotonic saline solution (1.6±0.9L). Severity of hemodynamic status was similar in both groups, but patients in the furosemide group were older and had a greater creatinine level. At 24h, only the furosemide group had a decreased shock index (0.82±0.22 vs. 0.63±0.16, P<0.0001) with improved systolic blood pressure (118±18 vs. 133±17mmHg, P<0.0001), and creatinine levels. After treatment, there were fewer patients with simplified pulmonary embolism severity index ≥1 in the diuretic group (45% vs. 55%, P=0.03) than in the fluid expansion group (47% vs. 40%, P<0.0001). Finally, oxygen requirement at 24h decreased only in the diuretic group (75% to 47%, P=0.0004), and in-hospital survival without death and PE-related shock were similar between the 2 groups. Conclusions: In normotensive PE with RV dilatation, diuretics may improve hemodynamics and oxygenation requirement.  (Circ J 2013; 77: 2612–2618)

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© 2013 THE JAPANESE CIRCULATION SOCIETY
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