FUROSEMIDE VS CHLOROTHIAZIDE & FUROSEMIDE IN DIURETIC RESISTANCE IN ILL CHILDREN

利尿是儿科危重病人管理的重要组成部分。这些患者由于多种因素而出现液体超载。达到适当的液体平衡对于临床改善通常是必要的。目前，儿科重症监护病房对利尿症的当地标准护理始于给药环状利尿剂速尿，剂量为每六小时1毫克/公斤。这种药物方案对大多数需要利尿的患者来说是足够的，但随着时间的推移，一些患者会对其影响产生抵抗力。目前，在这种情况下，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服用相同剂量的速尿，并添加另一种利尿剂氯噻嗪，它与速尿具有协同作用。这两种治疗方案在这一人群中的相对疗效尚不清楚，这两种方案都被认为是儿科重症监护病房的标准护理。在我们的研究中，我们建议调查对于对初始剂量速尿反应不足的患者，哪种治疗方案更好地实现利尿。

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.