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Acetazolamide does not affect COPD patient use of mechanical ventilation

No statistically significant reduction in the duration of invasive mechanical ventilation observed among patients with COPD receiving acetazolamide compared with placebo, according to the results from a multicenter study.

“Among mechanically ventilated patients with COPD and pure or mixed metabolic alkalosis, the use of effective acetazolamide doses, compared with placebo, did not result in a statistically significant reduction in the duration of invasive mechanical ventilation,” Christophe Faisy, MD, PhD, of the medical intensive care unit at European Georges Pompidou Hospital in Paris, and colleagues wrote. “However, the magnitude of the difference (16 hours) was clinically important, and it is possible that the study was underpowered to establish statistical significance.”

Faisy and colleagues evaluated 380 patients with COPD (mean age, 69 years; 71.6% men) from 15 intensive care units in France who received 500 mg to 1,000 mg of acetazolamide two times daily or placebo between 2011 and 2014, according to the abstract. Patients received acetazolamide up to 48 hours after admission and continued until discharge for up to 28 days.

The primary outcome was the duration of mechanical ventilation use through endotracheal intubation or tracheotomy.

The researchers observed no significant difference for median duration of mechanical ventilation (−16 hours; 95% CI, −36.5 to 4), daily changes of minute-ventilation (−0 L/min; 95% CI, −0.2 to 0.2), partial carbon dioxide pressure in the arterial blood (−0.3 mm Hg; 95% CI, −0.8 to 0.2) or duration of time for weaning off mechanical ventilation (−0.9 hours; 95% CI, −4.3 to 1.3) between groups, according to the abstract.

However, there was a significant decrease in the number of days with metabolic alkalosis (between-group difference, −1; 95% CI, −2 to −1) and daily changes of serum bicarbonate (between-group difference, −0.8 mEq/L; 95% CI, −1.2 to −0.5). – by Jeff Craven

Disclosure: Faisy reports no relevant financial disclosures. Please see the full study for a complete list of all other researchers’ relevant financial disclosures.