Authorship and contributorship
Acetazolamide improves oxygenation in patients with respiratory failure and metabolic alkalosis
Article first published online: 4 JUL 2013
© 2013 John Wiley & Sons Ltd
The Clinical Respiratory Journal
Volume 7, Issue 4, pages 390–396, October 2013
How to Cite
Gulsvik, R., Skjørten, I., Undhjem, K., Holø, L., Frostad, A., Saure, E. W., Lejlic, V., Humerfelt, S., Hansen, G. and Bruun Wyller, T. (2013), Acetazolamide improves oxygenation in patients with respiratory failure and metabolic alkalosis. The Clinical Respiratory Journal, 7: 390–396. doi: 10.1111/crj.12025
Torgeir Bruun Wyller is the guarantor of the study and is responsible for the integrity of the work as a whole, from conception and design to acquisition of data, analysis and interpretation of data, and writing of the manuscript. Ragnhild Gulsvik contributed to acquisition of data, data analysis and interpretation, and writing of the manuscript. Ingunn Skjørten contributed to data collection, interpretation and writing of the manuscript. Sjur Humerfelt contributed to interpretation and writing of the manuscript. Gunnar Hansen contributed to conception and design. Kenneth Undhjem, Lars Holø, Anne Frostad, Eirunn Waatevik Saure and Vasvija Lejlic contributed to data collection. All authors made important intellectual contributions and critical final revision of the manuscript.
The study was approved by the Regional Committee for Ethics in Medical Research, the Data Protection Authorities and the Norwegian Medicines Agency. After having received oral and written information, all patients gave written consent.
Conflict of interest
We declare that none of the authors have any support from any organisation for the submitted work, no financial relationships with any organisations that might have an interest in the submitted work, or any other relationships or activities that could appear to have influenced the submitted work.
- Issue published online: 23 SEP 2013
- Article first published online: 4 JUL 2013
- Accepted manuscript online: 12 APR 2013 04:09AM EST
- Manuscript Accepted: 7 APR 2013
- Manuscript Revised: 18 FEB 2013
- Manuscript Received: 22 OCT 2012
- acetazolamide ;
- chronic obstructive pulmonary disease ;
- hypoxia ;
- metabolic alkalosis ;
- respiratory failure
Coexistent respiratory failure and metabolic alkalosis is a common finding. Acidotic diuretics cause a fall in pH that may stimulate respiration.
The purpose of the study was to evaluate the effectiveness of short-term treatment with acetazolamide for combined respiratory failure and metabolic alkalosis.
A randomised, placebo-controlled and double-blind parallel group trial where oral acetazolamide 250 mg three times a day for 5 days were administered to patients hospitalised for respiratory failure because of a pulmonary disease (PaO2 ≤ 8 kPa and/or PaCO2 ≥ 7 kPa) who had concurrent metabolic alkalosis [base excess (BE) ≥8 mmol/L]. PaO2 after 5 days was the primary effect variable. Secondary effect variables were PaCO2, BE and pH on day 5, and the total number of days in hospital.
Of 70 patients enrolled (35 in each group), data from 54 were analysed per protocol, while last observation carried forward was used for the remaining 16. During the 5-day treatment, PaO2 increased on average 0.81 kPa in the placebo group and 1.41 kPa in the acetazolamide group. After adjustment for baseline skewness, the difference was statistically significant (adjusted mean difference 0.55 kPa, 95% confidence interval 0.03–1.06). PaCO2 decreased in both groups, but the difference was not statistically significant. As expected, pH and BE decreased markedly in the acetazolamide group.
Acetazolamide may constitute a useful adjuvant treatment mainly to be considered in selected patients with respiratory failure combined with prominent metabolic alkalosis or where non-invasive ventilation is insufficient or infeasible.