Acetazolamide in Mechanically Ventilated Patients with COPD: Is There a Benefit?

By Kathryn Radigan, MD

Attending Physician, Division of Pulmonary and Critical Care, Stroger Hospital of Cook County, Chicago

SYNOPSIS: Treating mechanically ventilated COPD patients with acetazolamide does not significantly lessen the duration of mechanical ventilation when compared to placebo.

SOURCE: Faisy C, Meziani F, Planquette B, et al. Effect of acetazolamide vs placebo on duration of invasive mechanical ventilation among patients with chronic obstructive pulmonary disease: A randomized clinical trial. JAMA 2016;315:480-488.

Despite a lack of reliable support for its use, acetazolamide is still often used in cases of mechanically ventilated COPD patients as a respiratory stimulant. In order to test acetazolamide treatment’s efficacy, Faisy et al undertook the 3-year, randomized, double-blind DIABOLO study. Three hundred and eighty-two COPD patients from 15 French ICUs expected to be under mechanical ventilation for more than a day were randomly assigned either a placebo treatment or the acetazolamide treatment. Patients with metabolic alkalosis received IV doses of between 500 and 1000 mg of acetazolamide twice a day for the entirety of their stay in the ICU. The primary dependent variable concerned was duration of mechanical ventilation, but secondary considerations included fluctuations in pulmonary parameters, duration of ICU stay, adverse effects and ICU mortality among others. Analysis of the patients that completed the study revealed no significant deviations between the placebo group and the acetazolamide group regarding median required time for mechanical ventilation, duration of weaning off mechanical ventilation, or partial carbon dioxide pressure in arterial blood. Differences were observed, however, in daily fluctuation of serum bicarbonate, and the number of days that patients experienced metabolic alkalosis, as both were significantly lessened in the acetazolamide patients. Concerns about this study being underpowered do not take away from the finding that the duration of mechanical ventilation for COPD patients is not significantly reduced by acetazolamide treatment.