No Difference in Ventilation Treatment for COPD Patients Treated with Acetazolamide

The drug acetazolamide does not significantly reduce the duration of mechanical ventilation for chronic obstructive pulmonary disease (COPD) patients in intensive care units (ICUs), according to findings published in JAMA.

Researchers from the European Georges Pompidou Hospital in Paris studied 187 randomized COPD patients between October 2011 and July 2014 in the ICU in order to determine whether acetazolamide reduces mechanical ventilation duration in critically ill patients with COPD and metabolic alkalosis. The patients who were expected to receive mechanical ventilation for more than 24 hours were included into either the acetazolamide or placebo group, while an additional 193 were included in a typical care cohort.

Between 500 and 1000 mg of medication twice daily was administered intravenously if the patients had pure or mixed metabolic alkalosis, and began within 48 hours of ICU admission. The drug continued for the duration of the ICU stay for a maximum of 28 days.

The researchers reported no significant differences among patients in the acetazolamide group compared to the placebo group in measures of median duration of mechanical ventilation. There were not any reported differences among measures of duration of weaning off mechanical ventilation or for other respiratory parameter values (such as respiratory frequency, tidal volume or minute ventilation).

The one major difference that the investigators noted was that the daily changes in serum bicarbonate and number of days with metabolic alkalosis decreased significantly more in the acetazolamide group throughout the study.

There were additional measurements that did not show any differences between the acetazolamide or placebo control group: adverse events, use of noninvasive ventilation after intubation, the duration of ICU stay and in-ICU mortality.

However, the researchers warned that the duration of invasive mechanical ventilation must be taken only as a preliminary finding: “Indeed, the study may have identified a clinically important benefit of acetazolamide for the primary end point that did not demonstrate statistical significance because of a possible lack of power,” the study authors concluded.