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
Por:
Cervera, GR, Puigdevall, JMR, Chorro, IM, Delgado, MCM, la Calle, GH, Serra, AM, Perapoch, IV
Publicada:
1 jun 2017
Resumen:
Background: 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.
Methods: 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 > 735 and bicarbonate > 26 mmol/L. Clinical, respiratory and laboratory parameters were recorded.
Results: 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%Cl, -2.1-4.8; p = 0.44). Kaplan-Meiercurves 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: PaCO2 55 (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 ALTZ administration.
Conclusions: Among patients with MA and COPD or OHS, early treatment with ACTZ did not shorten significantly the duration of MV compared with placebo. (c) 2017 Elsevier Ltd. All rights reserved.
Filiaciones:
Cervera, GR:
Hosp Son Llatzer, Intens Care Dept, Carretera Manacor,Km 4, Palma De Mallorca 07198, Illes Balears, Spain
Puigdevall, JMR:
Hosp Son Espases, Intens Care Dept, Carretera Valldemossa,79, Palma De Mallorca 07010, Spain
Chorro, IM:
Hosp Santa Creu & Sant Pau, Intens Care Dept, C St Quinti,89, Barcelona 08026, Spain
Delgado, MCM:
Hosp Univ Torrejon de Ardoz, Intens Care Dept, C Mateo Inurria,S-N, Torrejon De Ardoz 28850, Spain
la Calle, GH:
Hosp Univ Torrejon de Ardoz, Intens Care Dept, C Mateo Inurria,S-N, Torrejon De Ardoz 28850, Spain
Hosp Infanta Leonor, Intens Care Dept, Ave Gran Via Este,80, Madrid 28031, Spain
Serra, AM:
Hosp Moises Broggi, Intens Care Dept, C Jacint Verdaguer,90, St Joan Despi 08970, Spain
Perapoch, IV:
Hosp St Joan Reus, Intens Care Dept, Ave Dr Josep Laporte,2, Reus 43204, Spain
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