title: Effect of acetazolamide on post-NIV metabolic alkalosis in acute exacerbated COPD patients.
abstract: OBJECTIVE
  Non-invasive ventilation (NIV) is an effective treatment in patients with acute exacerbation of COPD (AECOPD). However, it may induce post-hypercapnic metabolic alkalosis (MA). This study aims to evaluate the effect of acetazolamide (ACET) in AECOPD patients treated with NIV.
  
  
  METHODS
  Eleven AECOPD patients, with hypercapnic respiratory failure and MA following NIV, were treated with ACET 500 mg for two consecutive days and compared to a matched control group. Patients and controls were non invasively ventilated in a bilevel positive airway pressure (BiPAP) mode to a standard maximal pressure target of 15-20 cmH2O.
  
  
  RESULTS
  ACET intra-group analysis showed a significant improvement for PaCO2 (63.9 ± 9.8 vs. 54.9 ± 8.3 mmHg), HCO3- (43.5 ± 5.9 vs. 36.1 ± 5.4 mmol/L) and both arterial pH (7.46 ± 0.06 vs. 7.41 ± 0.06) and urinary pH (6.94 ± 0.77 vs 5.80 ± 0.82), already at day 1. No significant changes in endpoints considered were observed in the control group at any time-point. Inter-group analysis showed significant differences between changes in PaCO2 and HCO3- (delta), both at day 1 and 2. Furthermore, the length of NIV treatment was significantly reduced in the ACET group compared to controls (6 ± 8 vs. 19 ± 19 days). No adverse events were recorded in the ACET and control groups.
  
  
  CONCLUSIONS
  ACET appears to be effective and safe in AECOPD patients with post-NIV MA.
authors.affiliation: Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy. stemapa@libero.it.
authors.forename: V
authors.initials: V
authors.lastname: Fontana
authors.forename: S
authors.initials: S
authors.lastname: Santinelli
authors.forename: M
authors.initials: M
authors.lastname: Internullo
authors.forename: P
authors.initials: P
authors.lastname: Marinelli
authors.forename: L
authors.initials: L
authors.lastname: Sardo
authors.forename: G
authors.initials: G
authors.lastname: Alessandrini
authors.forename: L
authors.initials: L
authors.lastname: Borgognoni
authors.forename: A M
authors.initials: AM
authors.lastname: Ferrazza
authors.forename: M
authors.initials: M
authors.lastname: Bonini
authors.forename: P
authors.initials: P
authors.lastname: Palange
mesh_terms: D000086:Acetazolamide / Q000627:therapeutic use*; D000136:Acid-Base Equilibrium / Q000187:drug effects; D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000471:Alkalosis / Q000209:etiology*; D002257:Carbonic Anhydrase Inhibitors / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006935:Hypercapnia / Q000628:therapy; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation / Q000009:adverse effects*; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000628:therapy; D012131:Respiratory Insufficiency / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D002257:Carbonic Anhydrase Inhibitors; D000086:Acetazolamide