***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: STUDY OBJECTIVE To compare the renal , hemodynamic , and pulmonary effects of a 6-hour infusion of furosemide versus conventional bolus administration in premature infants . DESIGN Prospect i ve , blinded , placebo-controlled , r and omized study . SETTING Two level III , university-based neonatal intensive care units . PATIENTS Thirty premature infants with significant lung disease , requiring furosemide after a red cell infusion . INTERVENTIONS Infants received furosemide 1 mg/kg over 2 minutes , followed by a 6-hour placebo infusion , or a small loading dose of 0.1 mg/kg , followed by a slow infusion of 0.9 mg/kg over 6 hours . Serum and urine were collected to determine percentage fractional excretion of sodium ( FENa ) . MEASUREMENTS AND MAIN RESULTS Urine output and blood pressure were measured every 2 hours after furosemide administration . Percentage FENa was measured immediately before furosemide and compared with pooled urine from an 8-hour collection after furosemide administration . Serum sodium , creatinine , and calcium were measured before and 24 hours after drug administration . Mean airway pressure and percentage inspired oxygen were compared before , 1 - 4 hours after , and 4 - 12 hours after drug administration . No significant differences were detected between the two methods of drug administration . CONCLUSION Our data suggest that a 6-hour infusion of furosemide does not offer substantial clinical advantage over conventional bolus administration in premature infants when focusing on urine output , blood pressure , FENa , or pulmonary effect BACKGROUND Transfusion-associated circulatory overload ( TACO ) is a frequent complication of blood transfusion . Investigations identifying risk factors for TACO in critically ill patients are lacking . STUDY DESIGN AND METHODS We performed a 2-year prospect i ve cohort study of consecutive patients receiving blood product transfusion in the medical intensive care unit ( ICU ) of the tertiary care institution . Patients were followed for development of transfusion-related complications . TACO was defined as acute hydrostatic pulmonary edema occurring within 6 hours of transfusion . In a nested case-control design , transfusion characteristics were compared between cases ( TACO ) and controls after matching by age , sex , and ICU admission diagnostic category . In a secondary analysis , patient characteristics before transfusion were compared between cases ( TACO ) and r and omly selected controls . RESULTS Fifty-one of 901 ( 6 % ) transfused patients developed TACO . Compared with matched controls , TACO cases had a more positive fluid balance ( 1.4 L vs. 0.8 L , p = 0.003 ) , larger amount of plasma transfused ( 0.4 L vs. 0.07 L , p = 0.007 ) , and faster rate of blood component transfusion ( 225 mL/hr vs. 168 mL/hr , p = 0.031 ) . In a secondary analysis comparing TACO cases and r and om controls , left ventricular dysfunction before transfusion ( odds ratio [ OR ] , 8.23 ; 95 % confidence interval [ CI ] , 3.36 - 21.97 ) and plasma ordered for the reversal of anticoagulant ( OR , 4.31 ; 95 % CI , 1.45 - 14.30 ) were significantly related to the development of TACO . CONCLUSION Volume of transfused plasma and the rate of transfusion were identified as transfusion-specific risk factors for TACO . Left ventricular dysfunction and fresh-frozen plasma ordered for the reversal of anticoagulant were strong predictors of TACO before the onset of transfusion Left ventricular filling pressure ( LVFP ) as reflected by pulmonary capillary wedge pressure ( PCWP ) was measured in 40 adult cases of chronic severe anemia ( CSA ) before and after transfusion of 1 unit of whole citrated blood , using Swan-Ganz monitoring catheters . The cases were r and omized into 4 groups of 10 each . Blood was transfused at a rate of 2 ml , 5 ml and 10 ml/min in groups A , B and C , respectively . In group D , blood transfusion ( BT ) was given at 5 ml/min but this group received , in addition , 40 mg furosemide intravenously just prior to the transfusion . Pretransfusion PCWP was normal in all the cases . Following BT the " wedge " pressure increased significantly in the first 3 groups , the rise being proportionately greater with faster transfusions ( 15.8 , 20.9 and 32.2 % in groups A , B and C , respectively ) . In group D , however , PCWP actually decreased by 21.7 % ( p less than 0.001 ) . As far as we know , this is the first study in which a definite and significant rise in PCWP has been documented following transfusion of blood even at conventional speed ( group A ) . The implication s of such an increase in " wedge " pressure as well as the observation that it can be completely blocked by furosemide are discussed . On the basis of these observations it is recommended that intravenous furosemide should be administered routinely before any BT in cases of CSA . Such practice will also permit blood to be transfused at a comparatively faster speed , without jeopardizing patient safety BACKGROUND The use of premedication to prevent acute transfusion reactions has been estimated to occur in 50 % to 80 % of transfusions . While this practice has some biologic rationale , few clinical studies have been performed to assess the efficacy of this practice , and the method ologic quality of these studies is variable . The primary objective of this study was to describe current practice s regarding transfusion premedication to prevent febrile nonhemolytic transfusion reactions , mild allergic transfusion reactions , and transfusion-associated circulatory overload . STUDY DESIGN AND METHODS We conducted an observational retrospective chart review of a stratified r and om sample of 324 transfusions that took place over a 6-month period . Data were abstract ed from medical records and then scanned into a data base for analysis . We calculated inter- and intraobserver agreement on key abstract ed data to estimate assessment error . A two-phase adjudication process was used to determine whether or not medications given before the time of each transfusion were intended as premedications . RESULTS Of the transfusions sample d , 1.6 % ( 95 % confidence interval , 0.4 - 3.9 ) were associated with premedication medications to prevent an acute transfusion reaction . Inter- and intraobserver reliability in the abstract ion of key data points was good . Good agreement in adjudicator classification of outcomes was achieved only when adjudicators were provided with patient source documents . CONCLUSIONS Premedication use was infrequent and much less common than previously reported . Improved methods of capturing transfusion premedication , which likely require prospect i ve assessment s , are needed for future research studies Summary An investigation was planned to establish whether direct transfusion of packed cells with added ethacrynic acid was as safe and effective as exchange transfusion in the management of severe an˦mia in pregnancy , when cardiac failure caused by an˦mia is either present or imminent . 93 pregnant Nigerian women with h˦matocrit readings between 5 % and 13 % were allocated at r and om to two treatment groups . One group received exchange transfusion and the other was managed by direct transfusion of packed cells to which ethacrynic acid had been added . Subsequent treatment was the same for both groups . Analysis of maternal and fetal outcome showed that the results achieved by the two methods of treatment was similar . In the 46 patients treated by exchange transfusion 1 mother and 12 fetuses were lost , compared with no maternal death and the loss of 11 fetuses in the 47 treated by direct transfusion and ethacrynic acid . Apart from its simplicity , the ethacrynic acid technique has the advantage that less donor blood is required . Direct blood-transfusion combined with ethacrynic acid is , therefore , recommended for the initial treatment of very severe an˦mia in pregnancy , except for patients who require emergency surgery and those in advanced labour , for whom exchange transfusion is still preferred Pulmonary capillary ' wedge ' pressures ( PCWP ) were measured in 20 adult cases of chronic severe anemia ( CSA ) before and after transfusion of 700 ml of whole blood at a rate of 5 ml/min . The cases were r and omly divided into 2 groups of 10 cases each . Group II also received 40 mg of furosemide immediately before the start of transfusion . The majority of the cases had hemoglobin values less than 4 g% and serum albumin values less than 2.5 g% . Pretransfusion intracardiac pressures were normal in all the cases . Following blood transfusion ( BT ) , appreciable rises ( p less than 0.001 ) in hemoglobin and arterial and venous oxygen saturation were observed . PCWP increased significantly after BT in Group I ( p less than 0.001 ) . Although it decreased by 3.75 % in Group II , this was not statistically significant ( p greater than 0.05 ) . This study implies that a blood transfusion of 700 ml , given at a speed of 5 ml/min in patients with CSA , results in sufficient hemodynamic stress to cause a significant rise in PCWP , and that this is completely prevented by simultaneous administration of 40 mg of furosemide OBJECTIVE To assess the effect of furosemide administered with packed red blood cell transfusion on cardiopulmonary variables of hemodynamically stable , electively transfused preterm infants beyond the first week of life . STUDY DESIGN A r and omized , stratified , double-blind , placebo-controlled trial of intravenous furosemide ( 1 mg/kg ) versus placebo ( normal saline ) just before " top-up " packed red blood cell transfusion ( 20 mL/kg over 4 hours ) in a tertiary neonatal intensive care unit . RESULTS The primary outcome was a change in fraction of inspired oxygen ( FiO(2 ) ) during the 24 hours posttransfusion compared with the 6-hour pretransfusion period . Secondary outcomes were functional echocardiographic and clinical /biochemical variables . Of 51 consecutive preterm infants with mean ( ± SD ) birth weights of 900 g ( ± 28 ) ; enrollment weights of 1342 g ( ± 432 ) ; birth gestation of 27 weeks ( ± 1 ) ; and postmenstrual age of 32 weeks ( ± 4 ) , 40 completed the study .  Pretransfusion variables were comparable between the furosemide ( n = 21 ) and placebo ( n = 19 ) groups . There was a small but significant increase ( P < .05 ) in posttransfusion FiO(2 )  in placebo ( relative increase of 7 % , equivalent to an absolute increase from 0.27 to 0.29 ) compared with the furosemide group . Other variables were similar . No infant received open-label furosemide . CONCLUSIONS Routine furosemide in electively transfused preterm infants confers minimal clinical benefits . Prevention of a clinical ly insignificant FiO(2 ) rise needs to be balanced against potential adverse effects 
    Output:
    
There was insufficient evidence to determine whether premedicating people undergoing blood transfusion with loop diuretics prevents clinical ly important transfusion-related morbidity .