FUROSEMIDE VS CHLOROTHIAZIDE & FUROSEMIDE IN DIURETIC RESISTANCE IN ILL CHILDREN

利尿是小儿危重症患者管理的重要组成部分。由于多种因素，这些患者会出现体液超载。达到适当的体液平衡通常是临床改善所必需的。目前，儿科重症监护室利尿的当地标准护理开始于每6小时1 mg/kg剂量的环状利尿剂速尿。这种药物治疗方案对大多数需要利尿的患者是足够的，但是随着时间的推移，一些患者对其影响产生了耐药性。目前，当这种情况发展时，有两种可供选择的战略。一种治疗方法是增加速尿的剂量。另一种治疗方法是继续使用相同剂量的呋塞米，并增加一种与呋塞米协同作用的利尿剂氯噻嗪。这两种治疗方案在该人群中的相对疗效尚不清楚，两种方案都被认为是儿科重症监护病房的标准治疗。在我们的研究中，我们建议研究哪一种治疗方法可以更好地实现对初始剂量呋塞米反应不足的患者的利尿。

Diuresis is an essential part of the management of critically ill pediatric patients. Fluid overload occurs in these patients due to multiple factors. Achievement of appropriate fluid balance is often necessary for clinical improvement. The local standard care for diuresis in the pediatric intensive care unit currently begins with administration of the loop diuretic, furosemide, at a dose of 1 mg/kg every six hours. This medication regimen is adequate for the majority of patients requiring diuresis however some patients develop resistance to its affects over time. At present, there are two alternative stratgies utilized when this situation develops. One treatment is to increase the dosage of furosemide. The other treatment is to continue the same dose of furosemide and add an additional diuretic, chlorothiazide, which acts synergistically with furosemide. The relative efficacy of these two treatment regimens in this population is unkown and both regimens are considered standard care within the pediatric intensive care unit. In our study, we propose to investigate which is the better treatment for achieving diuresis in patients who have experienced inadequate response to initial dosages of furosemide.