Effect of furosemide deresuscitation on fluid distribution and bioelectrical impedance analysis parameters in septic patients: a secondary analysis of a double-blind, randomized controlled trial
DOI:
https://doi.org/10.62838/jccm-2026-0051Keywords:
Bioelectrical impedance analysis, Fluid distribution, Furosemide deresuscitation, SepsisAbstract
Introduction: Sepsis is a leading cause of mortality globally, accounting for 11 million deaths annually, particularly in ICU patients. Fluid therapy is critical in sepsis management, yet aggressive resuscitation often leads to fluid overload, worsening outcomes. Bioelectrical impedance analysis (BIA) is a noninvasive method for monitoring body fluid distribution, providing insights into fluid imbalances associated with sepsis mortality.
Aim: This study evaluates the impact of furosemide-induced fluid deresuscitation on fluid distribution and clinical outcomes in sepsis patients.
Methods: A secondary analysis of a double-blind, randomized controlled trial was conducted in forty sepsis patients with cumulative fluid balance >1,500 mL and urine output <0.8 mL/kg/hour. Patients were randomized into intervention (furosemide infusion) and control (placebo) groups. BIA was used to assess total body water (TBW), extracellular water (ECW), intracellular water (ICW), and related parameters at baseline and after 48 hours. Outcomes included changes in fluid distribution, ICU length of stay, RRT use, and 28-day mortality.
Results: At baseline, no significant differences were observed in demographic or clinical characteristics between the groups. All BIA parameters showed no significant differences, except for the ECW/ICW ratio and ICW levels. After 48 hours, the intervention group exhibited a significant reduction in ECW/ICW ratio (P = 0.005) and ICW levels (P = 0.004), while the control group showed increases in ICW and TBW. Mortality rates were higher in the control group (36.8% vs. 25.0%), though not statistically significant (P = 0.423). Severe hypoalbuminemia was more frequent in the control group, potentially contributing to fluid imbalance.
Conclusions: BIA-guided monitoring of fluid dynamics and furosemide-induced deresuscitation may improve fluid management and outcomes in sepsis.
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Copyright (c) 2026 Dita Aditianingsih, Jefferson Hidayat, Anne Suwan Djaja, Theodorus Samuel Rahardja (Author)
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