title: Effects of early administration of acetazolamide on the duration of mechanical ventilation in patients with chronic obstructive pulmonary disease or obesity-hypoventilation syndrome with metabolic alkalosis. A randomized trial.
abstract: Metabolic alkalosis (MA) inhibits respiratory drive and may delay weaning from mechanical ventilation (MV). MA is common in CO2-retainer patients that need MV. Acetazolamide (ACTZ) decreases serum bicarbonate concentration and stimulates respiratory drive. This study evaluated the effects of ACTZ on the duration of MV in patients with MA and COPD or obesity hypoventilation syndrome (OHS) intubated with acute respiratory failure.
  
  
  
  Multicenter, randomized, controlled, double-blind study, with COPD or OHS patients with MV < 72 h and initial bicarbonate >28 mmol/L and pH > 7.35. Test-treatment, ACTZ 500 mg or placebo, was daily administered if pH > 7.35 and bicarbonate >26 mmol/L. Clinical, respiratory and laboratory parameters were recorded.
  
  
  
  47 patients (36 men) were randomized. There were no significant differences between groups in comorbidities, baseline characteristics or arterial blood gases at inclusion. The mean difference in the duration of MV between placebo and ACTZ group was 1.3 days (95%CI, -2.1-4.8; p = 0.44). Kaplan-Meier curves showed no differences in the duration of MV (Log-Rank p = 0.41). Between-group comparison of estimated marginal means (CI 95%) during MV were, respectively: PaCO255 (51-59) vs 48 (47-50) mm Hg, p = 0.002; bicarbonate concentration 34 (32-35) vs 29 (28-30) mmol/L, p < 0.0001; and minute volume 9.7 (8.9-10.4) vs 10.6 (9.2-12.0) L/min, p = 0.26. There were no severe adverse effects with ACTZ administration.
  
  
  
  Among patients with MA and COPD or OHS, early treatment with ACTZ did not shorten significantly the duration of MV compared with placebo.
  
  
  
  clinical.trials.gov; NCT01499485; URL:.www.clinicaltrials.gov.
authors.affiliation: Intensive Care Department, Hospital Son Llàtzer, carretera de Manacor, km 4, 07198 Palma de Mallorca, Spain. Electronic address: grialp@gmail.com.
authors.forename: G
authors.initials: G
authors.lastname: Rialp Cervera
authors.affiliation: Intensive Care Department, Hospital Son Espases, carretera de Valldemossa, 79, 07010 Palma de Mallorca, Spain. Electronic address: joan.raurich@ssib.es.
authors.forename: J M
authors.initials: JM
authors.lastname: Raurich Puigdevall
authors.affiliation: Intensive Care Department, Hospital de la Santa Creu i Sant Pau, c/ Sant Quintí, 89, 08026 Barcelona, Spain. Electronic address: imoran@santpau.cat.
authors.forename: I
authors.initials: I
authors.lastname: Morán Chorro
authors.affiliation: Intensive Care Department, Hospital Universitario Torrejón de Ardoz, c/ Mateo Inurria, s/n, 28850 Torrejón de Ardoz, Spain. Electronic address: mmartin@torrejonsalud.com.
authors.forename: M C
authors.initials: MC
authors.lastname: Martín Delgado
authors.affiliation: Intensive Care Department, Hospital Universitario Torrejón de Ardoz, c/ Mateo Inurria, s/n, 28850 Torrejón de Ardoz, Spain; Intensive Care Department, Hospital Infanta Leonor, Av. Gran Vía del Este,80, 28031 Madrid, Spain. Electronic address: gabihache@hotmail.com.
authors.forename: G
authors.initials: G
authors.lastname: Heras la Calle
authors.affiliation: Intensive Care Department, Hospital Moisès Broggi, c/ Jacint Verdaguer, 90, 08970 Sant Joan Despí, Spain. Electronic address: arantxa.mas@sanitatintegral.org.
authors.forename: A
authors.initials: A
authors.lastname: Mas Serra
authors.affiliation: Intensive Care Department, Hospital Sant Joan de Reus, Av. del Dr Josep Laporte, 2, 43204 Reus, Spain. Electronic address: ivallverdu@grupsagessa.com.
authors.forename: I
authors.initials: I
authors.lastname: Vallverdú Perapoch
mesh_terms: D000086:Acetazolamide / Q000008:administration & dosage*; D000138:Acidosis / Q000628:therapy*; D000368:Aged; D001639:Bicarbonates / Q000097:blood; D001784:Blood Gas Analysis; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010845:Obesity Hypoventilation Syndrome / Q000628:therapy*; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D012121:Respiration, Artificial / Q000379:methods*; D013997:Time Factors
chemical_list: D001639:Bicarbonates; D000086:Acetazolamide
keywords: Acetazolamide; COPD; Mechanical ventilation; Metabolic alkalosis; Obesity hypoventilation syndrome