***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: Objective : To compare the amount of furosemide needed to fulfil defined criteria for renal output if given intermittently or as a continuous infusion and to compare the effect of these two regimens on hemodynamic variables and urine electrolyte concentrations . Design : Prospect i ve r and omized study of postoperative hemodynamically stable pediatric cardiac patients . The patients were given furosemide according to the urine output , either as an intermittent bolus injection or as a continuous infusion . Setting : Pediatric intensive care unit in a university hospital Patients : The patients were r and omly assigned before admission to either the intermittent i. v. or the continuous furosemide i. v. infusion group . Measurements and results : Demographic and hemodynamic data were recorded for a maximum of 72 h , as were  furosemide dose , urine output , and fluid and inotropic drug requirements .  Forty-six patients completed the study .  Maximal hourly urine output was significantly higher in the intermittent group . A significantly lower dose of furosemide in the intermittent group produced the same 24-h urine volume as in the continuous infusion group . Conclusions : Intermittent furosemide administration may be recommended in hemodynamically stable postoperative pediatric cardiac patients because of less drug requirement . However , the high maximal urine output may cause hemodynamic problems in patients who depend on high inotropic support BACKGROUND Use of intravenous furosemide is generally avoided in critically ill neonates and infants soon after open heart operations to prevent fluctuations in intravascular volume and result ing circulatory instability . METHODS To assess and compare the safety and efficacy of continuous versus intermittent intravenous furosemide , we undertook a prospect i ve , r and omized trial in 26 consecutive patients less than 6 months of age . Inclusion criteria were presence of low-output syndrome requiring inotropic support ( 24/26 patients ) or pulmonary hypertension requiring vasodilator therapy ( 10/26 patients ) within 6 hours of discontinuation of cardiopulmonary bypass . Eleven patients received 0.1 mg x kg(-1 ) x h(-1 ) continuous intravenous furosemide ( group 1 ) and 15 received 1 mg/kg bolus every 4 hours ( group 2 ) for 24 hours . Mean age ( 3.7 + /- 3.4 versus 1.8 + /- 2.5 months ) and weight ( 4.6 + /- 2.1 versus 4.3 + /- 1.7 kg ) were comparable . RESULTS Group 2 infants showed slightly greater absolute urinary output ( 2.5 + /- 1.1 mL/kg per hour versus 3.3 + /- 1.1 mL/kg per hour , p = 0.05 ) . However , urinary output per dose of drug was significantly larger in group 1 infants ( 1.0 + /- 0.4 versus 0.5 + /- 0.2 mL x kg(-1 ) x h(-1 ) ; p = 0.002 ) with lesser fluctuations ( variance , 1.9 + /- 1.6 versus 3.8 + /- 2.1 ; p = 0.02 ) and fluid replacement needs ( 20.6 + /- 3.8 versus 51.8 + /- 14.4 ; p = 0.001 ) . Electrolyte replacement requirements were similar . A trend toward greater hemodynamic instability in group 2 patients ( heart rate variance 88.4 + /- 79.8 versus 128.3 + /- 82.7 ; p = 0.09 ; central venous pressure variance 2.8 + /- 1.90 versus 4.1 + /- 3.7 ; p = 0.07 ; mixed venous oxygen saturation variance , 32.3 + /- 27.6 versus 45.7 + /- 20.4 ; p = 0.06 ) was noted . All patients who completed the study protocol survived operation and were discharged home . CONCLUSIONS We conclude that ( 1 ) commonly used doses of both intermittent and continuous intravenous furosemide infusion can be safely administered to critically ill neonates and infants as early as 6 hours after operation , ( 2 ) continuous infusion yields an almost comparable urinary output with a much lower dose of furosemide , and ( 3 ) intermittent administration is associated with greater fluctuations in urinary output and greater needs for fluid replacement therapy BACKGROUND Routine diuretic administration after cardiopulmonary bypass is common despite the lack of evidence for its benefit . We performed a prospect i ve study to evaluate if diuretics assist in weight loss or alter clinical outcome . METHODS Seventy-nine patients undergoing primary elective coronary bypass surgery were r and omized to either diuretic ( fusemide and amiloride ) or placebo ( lactose ) postoperatively until preoperative weight was achieved or for 5 days in total . Proportions were compared with chi2 or Fisher 's exact test . RESULTS Forty patients were r and omized to diuretics and 39 to placebo . By day 5 , 97 % of patients ( 37 of 38 ) still in the diuretic arm , and 74 % of patients ( 29 of 39 ) in the placebo arm , achieved preoperative weight ( p = 0.02 ) . There were no differences in clinical outcomes . CONCLUSIONS Routine diuretics promote an earlier diuresis but no clinical benefits are apparent in low risk patients with normal renal function . Clinicians should reconsider routine diuretic prescription in this setting We prospect ively evaluated the diuretic effect of furosemide administered by bolus injection and by continuous infusion in 18 cardiac surgery patients . Nine patients were r and omly assigned to receive 0.3 mg/kg of furosemide as a bolus injection at time 0 and again 6 hours later ( nine patients ) or 0.05 mg/kg per hour of furosemide as a constant infusion for 12 hours ( nine patients ) . There were no significant differences between groups with respect to age , weight , creatinine clearance , changes in serum sodium and potassium levels , total urinary concentrations of sodium and potassium , or total urine volume for 12 hours . Diuresis during continuous infusion of furosemide was less variable from hour to hour than after bolus injection of furosemide and was sustained throughout the infusion period . Although the continuous infusion of furosemide will not provide the rapid and vigorous diuresis that is necessary in some clinical situations , it may be useful whenever a gentle , sustained diuresis is desired BACKGROUND Acute renal failure occurring in the postoperative period , requiring dialysis after cardiac surgery is an important risk factor for an early mortality , and the overall mortality of this complication is as high as 40 % to 60 % . Dialysis in the early postoperative period is often complicated by acute hemodynamic , metabolic , and hematologic effects that adversely affect cardiopulmonary function in patients stabilizing from recent surgery . The purpose of this study was to avoid the need for dialysis by infusion of the solution of mannitol , furosemide , and dopamine in the early postoperative period in oliguric renal failure . METHODS One hundred patients with postoperative oliguric or anuric renal failure despite adequate postoperative cardiac output and hemodynamic function were r and omized . Forty patients ( group A ) were given intermittent doses of diuretics ( furosemide , bumetadine , and ethracrynic acid ) and fluids .  Sixty patients ( group B ) were given continuous infusion of the solution of mannitol , furosemide , and dopamine ; the infusion was started within 6 hours ( mean 3.5 hours ) in subgroup B1 ( n = 30 ) , and later than 6 hours ( mean 7.5 hours ) in subgroup B2 ( n = 30 ) after the onset of renal failure . RESULTS Diuresis occurred in 93.3 % of group B ( n = 56 ) versus 10 % in group A ( n = 4 ; patients with preop normal renal function ) . Ninety percent of group A ( n = 36 ) required dialysis versus only 6.7 % of group B ( n = 4 ; patients with preexisting renal disease of subgroup B2 ) . Renal function returned to preoperative normal ( serum creatinine 0.9 + /- 0.05 , p < 0.0001 ) or baseline value ( serum creatinine 2.5 + /- 0.01 , p < 0.0001 ) after first postoperative week in subgroup B1 and third postoperative week in subgroup B2 . CONCLUSIONS Infusion of solution of mannitol , furosemide , and dopamine promoted diuresis in patients with acute postoperative renal failure with adequate postoperative cardiac output and had decreased the need for dialysis in the majority of patients . Early administration of this solution in acute renal failure caused early restoration of renal function to normal or baseline status . It remains to be determined whether routine administration of this solution in the early postoperative period for oliguric renal failure influences the long-term mortality and morbidity in those patients who do require dialysis Because development of acute renal failure is one of the most potent predictors of outcome in cardiac surgery patients , the prevention of renal dysfunction is of utmost importance in perioperative care . In a double-blind r and omized controlled trial , the effectiveness of dopamine or furosemide in prevention of renal impairment after cardiac surgery was evaluated . A total of 126 patients with preoperatively normal renal function undergoing elective cardiac surgery received a continuous infusion of either " renal-dose " dopamine ( 2 microg/kg per min ) ( group D ) , furosemide ( 0.5 microg/kg per min ) ( group F ) , or isotonic sodium chloride as placebo ( group P ) , starting at the beginning of surgery and continuing for 48 h or until discharge from the intensive care unit , whichever came first . Renal function parameters and the maximal increase of serum creatinine above baseline value within 48 h ( deltaCrea(max ) ) were determined . The increase in plasma creatinine was twice as high in group F as in groups D and P ( P < 0.01 ) . Acute renal injury ( defined as deltaCreamax ) > 0.5 mg/dl ) occurred more frequently in group F ( six of 41 patients ) than in group D ( one of 42 ) and group P ( zero of 40 ) ( P < 0.01 ) . ( The difference between group D and group P was not significant . ) Creatinine clearance was lower in group F ( P < 0.05 ) . Two patients in group F required renal replacement therapy . The mean volume of infused fluids , blood urea nitrogen , serum sodium , serum potassium , and osmolar- and free-water clearance was similar in all groups . It was shown that continuous infusion of dopamine for renal protection was ineffective and was not superior to placebo in preventing postoperative dysfunction after cardiac surgery . In contrast , continuous infusion of furosemide was associated with the highest rate of renal impairment . Thus , renaldose dopamine is ineffective and furosemide is even detrimental in the protection of renal dysfunction after cardiac surgery OBJECTIVE Acute kidney injury ( AKI ) is a devastating complication following cardiac surgery and the ideal management is controversial . This prospect i ve , r and omized , open-label and double-blinded study analyzed the renoprotective effects of furosemide infusion and intermittent bolus therapy administered with dopamine infusion in cardiac surgical patients . METHODS Between August 1 , 2007 and July 31 , 2008 , 100 adult patients undergoing elective coronary artery bypass surgery ( CABG ) surgery with normal renal function ( creatinine < 1.4 mg/dl ) were enrolled in the study . The patients were r and omized for the comparison of intermittent ( Group 1 , n=50 , 1mg-3mg/kg ) and continuous infusion of furosemide ( Group 2 , n=50 , 10mg/ml ) . Continuous variables were expressed as mean+/- SD and compared by unpaired Student 's t test or ANOVA for repeated measures . Statistical significance was assumed if p value was < 0.05 . RESULTS  Renal replacement therapy  ( RRT ) was used in 5 % of patients ( all in group 1 , p=0.028 ) . The 30-day mortality was 5 % . Only 2 patients became hemodialysis dependent in group 1 . Group 2 patients showed a continuous and higher urine output postoperatively than group 1 ( p<0.001 ) . Both groups had significant increase in peak postoperative serum creatinine values ( p<0.001 ) , however peak postoperative creatinine-clearance was significantly lower in group 1 ( p<0.001 ) . CONCLUSION Acute kidney injury necessitating RRT makes a small percentage of patients undergoing cardiac surgery and if RRT is not required the survival is excellent . Continuous infusion of furosemide seems to be effective in promoting diuresis and decreasing the need for RRT . However further multicenter studies with different doses of furosemide are required to confirm these results OBJECTIVE Renal dysfunction following cardiac surgery is more apparent in high-risk patients with pre-existing renal dysfunction , diabetes and impaired left-ventricular function , and following complicated procedures involving prolonged cardiopulmonary bypass ( CPB ) . The aim of this prospect ively r and omised double-blinded placebo-controlled study was to evaluate reno-protective effect of low-dose furosem 
    Output:
    
The systematic review of seven RCTs and one observational study has demonstrated that in patients who have undergone cardiac surgery , a more consistent and sustained diuresis is produced by a continuous infusion of furosemide compared with intermittent bolus doses of furosemide .
We conclude that continuous furosemide infusion in the perioperative period promotes a gentle and sustained diuresis in cardiac surgery patients .
The evidence supporting the benefit of this strategy in terms of reducing the need for RRT is weak .
At the same time , current best available evidence , albeit from small RCTs , suggests that the timely introduction of continuous furosemide infusion does not increase the incidence of renal impairment after cardiac surgery