Discussion
hyperchloremia, nephrotoxic, septic shock
HYPERCHLOREMIA, SEPTIC SHOCK
In this randomized placebo-controlled trial, combined furosemide and aminophylline improved the urine output, fluid balance and SOFA score and reduced the ICU, hospital and 28-day mortality, but this treatment had no impact on the BUN, Scr, Ccr, and GRF.This result is undoubtedly gratifying. In theory, furosemide can improve the renal function and can increase the urine output by increasing the renal blood flow. However, the results of some studies do not support this hypothesis. The use of furosemide does not improve the renal function, although it can increase the urine output [Usually, we use furosemide because the patient’s urine output is reduced, and our hope is to achieve our treatment goal of a negative fluid balance through the use of diuretics. Our study found that the intervention group had more urine output, a better negative fluid balance, a lower CVP, a reduced CRRT duration, a reduced SOFA score, and significantly reduced ICU mortality, hospital mortality, and 28-day mortality. We also noticed that the 28-day mortality rate in the control group was very high, almost twice as high as in the intervention group. We think this may be because the subjects in this experiment were septic shock patients with high APACHE II scores, low number of cases, and high mortality. In the Dinna N Cruz and Glenn H studies, enrolled patients with septic shock had APACHE II scores and 28-day mortality similar to ours [Some patients have a higher risk of hyperchloremia after undergoing full fluid resuscitation, especially after using normal saline. Results from a large study [Our research has certain limitations. It should be pointed out that some patients may have diuretic resistance, especially those who took diuretic drugs for a long time. Similarly, we did not have statistics and analysis of norepinephrine and nephrotoxic drugs. We cannot be sure that the improvement in the prognosis and the reduction in the mortality are the direct result of the combined use of furosemide and aminophylline. The same results were found in a study using furosemide alone, although that study was a retrospective study [