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Adjuvant acetazolamide in patients with acute severe exacerbation of COPD and noninvasive ventilation

https://doi.org/10.18093/0869-0189-2018-28-2-177-184

Abstract

The aim of the study was to investigate an efficacy of short-term treatment with acetazolamide (ACET) in patients with acute exacerbation of COPD (AECOPD) and noninvasive ventilation (NIV). Methods. This was a prospective case-control study. The study involved 20 patients. Inclusion criteria were as follows: AECOPD; pH > 7.33; PaCO2 > 48 mmHg; HCO3– > 26 mmol/L; and treatment with NIV. Clinical characteristics, Charlson comorbidity index, APACHE II score, arterial blood gases, and serum electrolytes were recorded before inclusion. Patients were defined as cases when they had received ACET (500 mg per day) for 3 days; they were compared to a matched control group who did not receive ACET. Clinical parameters, arterial blood gases, serum electrolytes, potential adverse effects, and length of hospital stay were monitored daily. Results. No significant differences in baseline characteristics, comorbidities, or concomitant drugs used were found between the groups. Mean duration of hospital stay was significantly shorter in the ACET group (16.2 ± 8.4 days vs 19.1 ± 2.8 days; p = 0.023). An iIntra-group analysis showed a significant improvement in clinical and arterial blood gas parameters in both groups already in the first day of the treatment. In the ACET group, systolic blood pressure (SBP), respiratory rate (RR), and SpO2 significantly improved at day 4 (112.5 ± 4.9 mmHg vs 125 ± 7.1 mmHg (p = 0.001); 15.2 ± 1.1 min–1 vs 17.1 ± 0.9 min–1 (p = 0.001) and 94.7 ± 1.1% vs 92.3 ± 0.8% (p = 0.0001), respectively). There was a significant decrease in PaCO2, pH and HCO3– at day 3 (48 ± 3.8 mmHg vs 52.4 ± 5.3 mmHg (p = 0.0288); 7.374 ± 0.4 vs 7.502 ± 0.17 (p = 0.0015) and 26.4 ± 2.8 mmol/L vs 36.9 ± 4.1 mmol/L (p = 0.00001), respectively) and day 4 (44 ± 2.4 mmHg vs 48.4 ± 4.6 mmHg (p = 0.0115); 7.387 ± 0.02 vs 7.480 ± 0.02 (p = 0.00001) and 24.2 ± 2.1 mmol/L vs 35.6 ± 3.0 mmol/L (p = 0.00001), respectively) in the ACET group. No adverse events were recorded in both groups. Conclusions. ACET adjuvant to NIV appears to be effective and could prevent post-NIV alkalosis occurrence and could reduce the length of hospital stay in patients with AECOPD and mixed metabolic disorders (respiratory acidosis and metabolic alkalosis).

About the Authors

Aung Kyaw Soe
N.I.Pirogov Federal Russian State National Research Medical University, Healthcare Ministry of Russia
Russian Federation
Postgraduate student, Department of Hospital Internal Medicine, Pediatric Faculty


G. S. Nuralieva
I.M.Sechenov First Moscow State Medical University, Healthcare Ministry of Russia (Sechenov University); Federal Pulmonology Research Institute, Federal Medical and Biological Agency of Russia
Russian Federation
Candidate of Medicine, Associate Professor, Department of Pulmonology, I.M.Sechenov First Moscow State Medical University, Healthcare Ministry of Russia (Sechenov University); Senior Researcher, Laboratory of Intensive Care and Respiratory Failure, Federal Pulmonology Research Institute, Federal Medical and Biological Agency of Russia


S. N. Avdeev
I.M.Sechenov First Moscow State Medical University, Healthcare Ministry of Russia (Sechenov University); Federal Pulmonology Research Institute, Federal Medical and Biological Agency of Russia
Russian Federation
Doctor of Medicine, Professor, Corresponding Member of Russian Academy of Sciences, Head of Department of Pulmonology, I.M.Sechenov First Moscow State Medical University, Healthcare Ministry of Russia (Sechenov University); Deputy Director for Science, Federal Pulmonology Research Institute, Federal Medical and Biological Agency of Russia; Chief Pulmonologist, Healthcare Ministry of Russia


A. G. Chuchalin
N.I.Pirogov Federal Russian State National Research Medical University, Healthcare Ministry of Russia
Russian Federation
Doctor of Medicine, Professor, Academician of Russian Academy of Sciences, Head of Department of Hospital Internal Medicine, Pediatric Faculty


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For citations:


Soe A.K., Nuralieva G.S., Avdeev S.N., Chuchalin A.G. Adjuvant acetazolamide in patients with acute severe exacerbation of COPD and noninvasive ventilation. PULMONOLOGIYA. 2018;28(2):177-184. (In Russ.) https://doi.org/10.18093/0869-0189-2018-28-2-177-184

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