Has anyone had any experience with aerosolized lasix for pulm edema ?
one NICU nurse brought the issue up for a vented neonate pte, but the peadiatrician balked: no studies i agreed.
turn up the peep
Why would aerosolizing lasix have any more effect on fluid than IV? Lasix Blocks chloride transport in the ascending limb and inhibits tubular sodium transport, causing a major loss of Na and Cl. Increases urinary losses of K and Ca and increases urine pH.
It does not act on the pulmonary system directly, only on the kidneys which in turn affects pulmonary system, so why aerosolize it?
It could be that using aerosolized lasix may be attempted because the lungs are viewed as a pharmaceutical delivery system superior to any of the traditional routes of administration such as IV, IM etc. The lungs have better absorption, more even absorption, and faster onset of action than IV, IM etc.
Here are some articles that support and don't support the use of inhaled Lasix. None of them, nor any that I could find support the use of inhaled Lasix for Pulmonary Edema. One even mentions that the neonatal patient had no effect on urinary output with inhaled lasix, so I do not see how that is going to help a pulmonary edema patient that need to get rid of fluid. I like almost everyone on this list remember from school that nebulization is a form of drug administration but as far as its effect on getting to the kidneys and effecting urinary outout the evidence that I have does not support it.
Am. J. Respir. Crit. Care Med., Volume 161, Number 6, June 2000, 1963-1967
Inhaled Furosemide Greatly Alleviates the Sensation of Experimentally Induced Dyspnea
TAKASHI NISHINO, TOHRU IDE, TOMOKO SUDO, and JIRO SATO
Furosemide is known to influence the activity of vagally mediated mechanoreceptors in the airways. Because vagal afferent fibers may play an important role in modulation of the sensation of dyspnea, it is possible that inhaled furosemide may modify the sensation of dyspnea.
2)© American Academy of Pediatrics, 1997. Volume 99(1), January
Pulmonary Effect of Inhaled Furosemide in Ventilated Infants With Severe Bronchopulmonary Dysplasia
Conclusion: We conclude that, under the conditions of our study, a single dose of 1 mg/kg inhaled furosemide does not improve the pulmonary mechanics in ventilator-dependent infants with severe BPD. Pediatrics 1997;99:71-75; bronchopulmonary dysplasia, pulmonary mechanics, loop diuretics, inhaled furosemide.
3)Archives of Disease in Childhood Fetal & Neonatal Edition
Archives of Disease in Childhood. Volume 77(1), July 1997, pp 32F-35F
Pulmonary function changes after nebulised and intravenous frusemide in ventilated premature infants
Results: Nebulised frusemide increased the tidal volume 31 (SE 11.5)% and compliance 34 (SE 12)% after two hours, whereas no change in either was noted for up to two hours after intravenous frusemide administration. Neither intravenous nor nebulised frusemide had any effect on airway resistance. Six hour urine output increased from a mean (SE) of 3.3 (0.4) ml/kg/hour to 5.9 (0.8) ml/kg/hour following intravenous frusemide administration while nebulised frusemide had no effect on urine output. Urinary sodium, potassium, and chloride losses were also significantly higher after intravenous frusemide, whereas nebulised frusemide did not increase urinary electrolyte losses.
4)Furosemide protective effect against airway obstruction. Source Current Drug Targets. 3(3):197-201, 2002 Jun.
Furosemide (frusemide) is mainly employed as a powerful diuretic that inhibits Na and K reabsorption in renal tubules. However other valuable pharmacological effects have been discovered that include a protective action from bronchospasm. The effects of furosemide on airways have been recognized to be more and more complex as far as an increasing amount of studies have been produced on this subject. The drug shows no acute bronchodilator effect, but prevents or attenuates bronchospasm caused by many factors, such as hyperpnea, drugs (metabisulphite, bradykinin, AMP), physical agents (hypo- and hypertonic aerosols), and allergen challenge in asthmatic patients.
There are many other articles that go along with the 4 that I have listed I just do not want to list them all. The all talk about the effects on smooth muscle and decreases in Dyspnea, none of them however mention fluid removal as a effect of nebulized Lasix.
AERSOLIZED LASIX CAUSES INCREASE PERMEABILITY OF THE PULMONARY VASCULATURE. IF ANYONE KNOWS ANYTHING ABOUT HOW IT DOES THAT PLEASE LET ME KNOW.
Of the many studies that I have read, they all say that aerosolized lasix is only effective at providing some relief in dyspnea, primarily in the cancer patient. Most studies admit that first, they do not fully understand why and second, that aerosolized lasix for use in the reduction of pulmonary edema shows no improvement over the parenteral route, however I am sure that we will run into more and more physicians that read a partial article and start to prescribe aerosolized lasix for everyone and then swear by it.
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