Effectiveness of acetazolamide for reversal of metabolic alkalosis in weaning COPD patients from mechanical ventilation.
OBJECTIVE
To evaluate the effects of a single daily dose of acetazolamide (ACET) on metabolic alkalosis and respiratory parameters in weaning chronic obstructive pulmonary disease (COPD) patients from invasive mechanical ventilation.


METHODS
Case-control study.


METHODS
An 18-bed intensive care unit (ICU) in a university hospital.


METHODS
Twenty-six intubated COPD patients with mixed metabolic alkalosis (serum bicarbonate >26 mmol/l and arterial pH >or=7.38) were compared with a historical control group (n = 26) matched for serum bicarbonate, arterial pH, age, and severity of illness at admission to ICU. ACET administration (500 mg intravenously) was monitored daily according to arterial blood gas analysis from readiness to wean until extubation.


RESULTS
ACET was administered 4 (1-11) days throughout the weaning period. Patients with ACET treatment significantly decreased their serum bicarbonate (p = 0.01 versus baseline) and arterial blood pH (p < 0.0001), increased their PaO(2)/FiO(2) ratio (p = 0.04), but did not change their PaCO(2) (p = 0.71). Compared with matched controls, administration of ACET did not improve arterial blood gas and respiratory parameters except PaO(2)/FiO(2) ratio (p = 0.03). ACET patients and their matched controls had similar duration of weaning. Extubation success rate was not significantly different between groups, and causes of reintubation were comparable.


CONCLUSIONS
ACET used at the dosage of 500 mg per day reduces metabolic alkalosis but has no benefit in terms of improving PaCO(2) or respiratory parameters in weaning COPD patients from mechanical ventilation.
Faisy
Christophe
C
Medical Intensive Care Unit, Hôpital Européen Georges Pompidou, Université Paris-Descartes, 20 rue Leblanc, Paris Cedex 15, France. christophe.faisy@egp.aphp.fr
Mokline
Amel
A
Sanchez
Olivier
O
Tadié
Jean-Marc
JM
Fagon
Jean-Yves
JY
D000086:Acetazolamide / Q000008:administration & dosage*; D000368:Aged; D000471:Alkalosis / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D001639:Bicarbonates / Q000097:blood; D002257:Carbonic Anhydrase Inhibitors / Q000008:administration & dosage*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000628:therapy*; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000009:adverse effects* / Q000379:methods; D012122:Ventilators, Mechanical / Q000009:adverse effects
D001639:Bicarbonates; D002257:Carbonic Anhydrase Inhibitors; D000086:Acetazolamide; D010100:Oxygen