guideline recommendations
HFSA 2006 Comprehensive Heart
Failure Practice Guideline
Section 12: Evaluation and Management of Patients With Acute Decompensated
Heart Failure
12.11 When congestion fails to improve in
response to diuretic therapy, the following options should be considered:
- Sodium and fluid restriction,
- Increasing doses of loop diuretic,
- Continuous infusion of a loop diuretic, or
- Addition of a second type of diuretic orally (metolazone or spironolactone)
or intravenously (chlorothiazide).
A fifth option, ultrafiltration,
may be considered.
"Ultrafiltration. Mechanical methods of
fluid removal are being actively investigated as potential alternatives
to pharmacologic diuresis. Small uncontrolled studies have long
suggested the utility of this approach using not only traditional
dialysis but hemofiltration methods. More recently, 2 studies examined
the utility of a peripheral venovenous system. Randomized controlled
clinical trials are underway to evaluate the potential use of this
treatment modality in patients with acute HF."
Adams KF, Lindenfeld J, Arnold JMO, Baker DW,
Barnard DH, Baughman KL, Boehmer JP, Deedwania P, Dunbar SB, Elkayam
U, Gheorghiade M, Howlett JG, Konstam MA, Kronenberg MW, Massie
BM, Mehra MR, Miller AB, Moser DK, Patterson JH, Rodeheffer RJ,
Sackner-Bernstein J, Silver MA, Starling RC, Stevenson LW, Wagoner
LE. HFSA 2006 Comprehensive Heart Failure Practice Guideline. J
Cardiac Failure 2006;12:e1–e122.
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