Treatment of Metabolic Alkalosis With Acetazolamide. Effect on the Length of Mechanical Ventilation.
Treatment of Metabolic Alkalosis With Acetazolamide. Effect on the Length of Mechanical Ventilation.
The purpose of this study is to analyze whether the treatment of metabolic alkalosis with
 acetazolamide in intubated patients with chronic obstructive pulmonary disease (COPD) or with
 obesity hypoventilation syndrome (OHS) reduces the length of mechanical ventilation (MV).
Metabolic alkalosis (MA) may reduce central respiratory drive, cardiac output and worsen
 oxygenation, leading to a delay in weaning from MV. Acetazolamide is a carbonic anhydrase
 inhibitor that is able to correct MA and to stimulate respiratory drive. There is a paucity
 of studies on the outcome of patients with MA under MV treated with acetazolamide.

 The primary objective of our study is to analyze whether the treatment of MA with
 acetazolamide in intubated patients with COPD or with OHS reduces the length of MV, reduces
 the length of ICU stay or ICU mortality. Complications associated with acetazolamide
 treatment will be also analyzed.

 Phase III double-blinded trial, with COPD or OHS patients under MV who have pH > 7,35 and
 bicarbonate > 28 mEq/L. Patients will be randomized to receive 500 mg of acetazolamide or
 placebo. According to arterial blood gas analysis (ABGA) values treatment administration will
 be evaluated daily until extubation.
Inclusion Criteria:

 -  Patients with COPD or obesity hypoventilation syndrome on invasive mechanical
 ventilation during less than 72 h with metabolic alkalosis, defined as a pH > 7.35 and
 actual bicarbonate > 28 mmol/L, and with potassium plasmatic levels >= 4 mEq/L.

 Exclusion Criteria:

 -  Postoperative patients.

 -  Previous psychiatric disease.

 -  Epilepsy.

 -  Pregnancy.

 -  Hepatic cirrhosis.

 -  Sulfonamide or acetazolamide allergy.

 -  Plasmatic creatinine > 2.5 mg/dL or creatinine clearance < 20 mL/min or continuous
 renal replacement techniques.

 -  Intolerance to enteral feeding.

 -  Administration in the previous 72 h of bicarbonate or acetazolamide.

 -  Terminal disease.