Acetazolamide for Respiratory Failure in Combination With Metabolic Alkalosis

University of Oslo School of Pharmacy70 enrolled

Overview

Respiratory failure is a common consequence of chronic obstructive pulmonary disease (COPD). A concurrent metabolic alkalosis may worsen the respiratory failure, as a higher pH in blood (and thus in cerebrospinal fluid) results in a weaker respiratory drive. Use of diuretics is the most common cause of metabolic alkalosis. When a patient with an acute exacerbation of a respiratory failure is also alkalotic, there are (at least theoretical) reasons to lower the pH in order to increase the respiratory drive. Among other alternatives, the drug acetazolamide can be used for this purpose. In some hospitals there is a tradition for the use of acetazolamide on this indication, but any evidence for the effect of such a treatment is rather weak. Thus, the aim of this trial is to evaluate the effect of acetazolamide as an adjuvant treatment for hospitalized patients with acute exacerbation of respiratory failure in combination with metabolic alkalosis.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

Conditions

Respiratory Insufficiency Alkalosis

Interventions

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Arterial pO2 8 kPa or lower, and arterial pCO2 7 kPa or higher. * Base Excess 8 mmmol/l or higher. * Written informed consent Exclusion Criteria: * Acetazolamide treatment regarded as obviously indicated or obviously contraindicated * Already using acetazolamide * Moribund patient * Unable to give fully informed consent * Allergy towards the tablet content or unable to swallow the tablets * Pregnant or breast-feeding

Locations (5)

Department of Respiratory Medicine, Haukeland University Hospital

Bergen, Norway

Department of Internal Medicine, Sorlandet Sykehus Kristiansand

Kristiansand, Norway

Department of Internal Medicine, Aker University Hospital

Oslo, Norway

Ullevaal University Hospital, Dept. of Respiratory Medicine

Oslo, Norway

Department of Internal Medicine, St.Olav's Hospital

Trondheim, Norway

Outcomes

Primary Outcomes

Partial pressure of oxygen in arterial blood on the 5th day of treatment (without extra oxygen)

Change in partial pressure of oxygen from start of treatment to the fifth day of treatment

Secondary Outcomes

Partial pressure of carbon dioxide in arterial blood on the 5th day of treatment.

Change in partial pressure of carbon dioxide from start of treatment to the fifth day of treatment

Intrahospital deaths

Use of mechanical ventilation

Length of stay

Side effects