Administration of acetazolamide did not reduce the duration of invasive mechanical ventilation among patients with COPD and metabolic alkalosis in a recent study.

Christophe Faisy, MD, PhD, of the European Georges Pompidou Hospital, Paris, and colleagues randomly assigned 382 patients with COPD who were expected to receive mechanical ventilation for more than 24 hours to acetazolamide (500-1000 mg, twice daily) or placebo, administered intravenously in cases of pure or mixed metabolic alkalosis. Treatment was initiated within 48 hours of ICU admission and continued during the ICU stay for a maximum of 28 days; 380 patients were included in an intention-to treat analysis. The study was conducted from October 2011 through July 2014 in 15 ICUs in France. The primary outcome was the duration of invasive mechanical ventilation via endotracheal intubation or tracheotomy.

Among 382 randomized patients, 380 completed the study. For the acetazolamide group (n = 187), compared with the placebo group (n = 193), no significant between-group differences were found for median duration of mechanical ventilation (-16.0 hours), duration of weaning off mechanical ventilation (-0.9 hours), or for other respiratory parameter-values (respiratory frequency, tidal volume, and minute ventilation), although daily changes of serum bicarbonate and number of days with metabolic alkalosis decreased significantly more in the acetazolamide group.

Secondary outcomes, such as adverse events, use of noninvasive ventilation after extubation, the duration of ICU stay, and in-ICU mortality, did not differ significantly between groups.

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