Abstract：
Metabolic alkalosis may lead to respiratory inhibition and increased need for ventilatory support or prolongation of weaning from ventilation for patients with chronic respiratory disease. Acetazolamide can reduce alkalaemia and may reduce respiratory depression.
We searched Medline, EMBASE and CENTRAL from inception to March 2022 for randomised controlled trials comparing acetazolamide to placebo in patients with chronic obstructive pulmonary disease, obesity hypoventilation syndrome or obstructive sleep apnoea, hospitalised with acute respiratory deterioration complicated by metabolic alkalosis. The primary outcome was mortality and we pooled data using random-effects meta-analysis. Risk of bias was assessed using the Cochrane RoB 2 (Risk of Bias 2) tool, heterogeneity was assessed using the I2 value and χ2 test for heterogeneity. Certainty of evidence was assessed using GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) methodology.
Four studies with 504 patients were included. 99% of included patients had chronic obstructive pulmonary disease. No trials recruited patients with obstructive sleep apnoea. 50% of trials recruited patients requiring mechanical ventilation. Risk of bias was overall low to some risk. There was no statistically significant difference with acetazolamide in mortality (relative risk 0.98 (95% CI 0.28 to 3.46); p=0.95; 490 participants; three studies; GRADE low certainty) or duration of ventilatory support (mean difference -0.8 days (95% CI -7.2 to 5.6); p=0.36; 427 participants; two studies; GRADE: low certainty).
Acetazolamide may have little impact on respiratory failure with metabolic alkalosis in patients with chronic respiratory diseases. However, clinically significant benefits or harms are unable to be excluded, and larger trials are required.
CRD42021278757.
We searched Medline, EMBASE and CENTRAL from inception to March 2022 for randomised controlled trials comparing acetazolamide to placebo in patients with chronic obstructive pulmonary disease, obesity hypoventilation syndrome or obstructive sleep apnoea, hospitalised with acute respiratory deterioration complicated by metabolic alkalosis. The primary outcome was mortality and we pooled data using random-effects meta-analysis. Risk of bias was assessed using the Cochrane RoB 2 (Risk of Bias 2) tool, heterogeneity was assessed using the I2 value and χ2 test for heterogeneity. Certainty of evidence was assessed using GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) methodology.
Four studies with 504 patients were included. 99% of included patients had chronic obstructive pulmonary disease. No trials recruited patients with obstructive sleep apnoea. 50% of trials recruited patients requiring mechanical ventilation. Risk of bias was overall low to some risk. There was no statistically significant difference with acetazolamide in mortality (relative risk 0.98 (95% CI 0.28 to 3.46); p=0.95; 490 participants; three studies; GRADE low certainty) or duration of ventilatory support (mean difference -0.8 days (95% CI -7.2 to 5.6); p=0.36; 427 participants; two studies; GRADE: low certainty).
Acetazolamide may have little impact on respiratory failure with metabolic alkalosis in patients with chronic respiratory diseases. However, clinically significant benefits or harms are unable to be excluded, and larger trials are required.
CRD42021278757.
摘要：
背景：代谢性碱中毒可能导致慢性呼吸道疾病患者的呼吸抑制和对通气支持或延长脱机时间的需求增加。乙酰唑胺可以减少碱性血症，并可以减少呼吸抑制。
方法：我们搜索了Medline，EMBASE和CENTRAL从开始到2022年3月，用于比较乙酰唑胺与安慰剂在慢性阻塞性肺疾病患者中的随机对照试验，肥胖低通气综合征或阻塞性睡眠呼吸暂停，因急性呼吸恶化并发代谢性碱中毒而住院。主要结果是死亡率，我们使用随机效应荟萃分析汇总数据。使用CochraneRoB2（偏差风险2）工具评估偏差风险，异质性使用I2值和χ2检验评估异质性。使用等级(建议等级，评估,发展,和评价)方法。
结果：纳入了4项研究，共504名患者。99%的患者患有慢性阻塞性肺疾病。没有试验招募阻塞性睡眠呼吸暂停患者。50%的试验招募了需要机械通气的患者。偏倚的风险总体上很低，有一定的风险。与乙酰唑胺在死亡率（相对风险0.98（95％CI0.28至3.46）；p=0.95；490名参与者；三项研究；GRADE低确定性）或通气支持持续时间（平均差异-0.8天（95％CI-7.2至5.6）；p=0.36；427名参与者；两项研究；GRADE：低确定性）方面无统计学差异。
结论：乙酰唑胺对慢性呼吸系统疾病合并代谢性碱中毒的呼吸衰竭的影响不大。然而,临床上的重大益处或危害无法排除，需要更大的试验。
■CRD42021278757。
方法：我们搜索了Medline，EMBASE和CENTRAL从开始到2022年3月，用于比较乙酰唑胺与安慰剂在慢性阻塞性肺疾病患者中的随机对照试验，肥胖低通气综合征或阻塞性睡眠呼吸暂停，因急性呼吸恶化并发代谢性碱中毒而住院。主要结果是死亡率，我们使用随机效应荟萃分析汇总数据。使用CochraneRoB2（偏差风险2）工具评估偏差风险，异质性使用I2值和χ2检验评估异质性。使用等级(建议等级，评估,发展,和评价)方法。
结果：纳入了4项研究，共504名患者。99%的患者患有慢性阻塞性肺疾病。没有试验招募阻塞性睡眠呼吸暂停患者。50%的试验招募了需要机械通气的患者。偏倚的风险总体上很低，有一定的风险。与乙酰唑胺在死亡率（相对风险0.98（95％CI0.28至3.46）；p=0.95；490名参与者；三项研究；GRADE低确定性）或通气支持持续时间（平均差异-0.8天（95％CI-7.2至5.6）；p=0.36；427名参与者；两项研究；GRADE：低确定性）方面无统计学差异。
结论：乙酰唑胺对慢性呼吸系统疾病合并代谢性碱中毒的呼吸衰竭的影响不大。然而,临床上的重大益处或危害无法排除，需要更大的试验。
■CRD42021278757。
