Alkalosis, Metabolic, Ventilator Weaning
Conditions
Keywords
mechanical ventilation weaning phase patients with metabolic alkalosis
Brief summary
Metabolic alkalosis(MA) is common metabolic disorder in ICU setting. MA could be cause of weaning failure or delay by depression of respiratory center. The purpose of this study is to evaluate that correction of MA by administration of acetazolamide facilitates weaning of mechanical ventilation.
Interventions
DRUGacetazolamide
If ABGA is pH ≥ 7.43 & HCO3- ≥ 26mEq/L at 7am, they will receive acetazolamide 500mg via IV q 24h. If ABGA is pH ≤ 7.35 at 7am, acetazolamide will skip.
DRUGSaline
They will receive saline 50ml via IV q 24h.
Sponsors
Asan Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Patients on mechanical ventilation for at least 24 hours with an assisted mode and passed acute resuscitation and considered for weaning. (Definition of Weaning point: 1. Oxygenation * FiO2 ≤ 0.4 & PaO2 ≥ 60 mmHg * O2 index (PaO2/FiO2) ≥ 150 * SaO2 \> 90% * PEEP ≤ 5 cmH2O * MN ≤ 15 L/min 2. Vital sign * Stable BP: MAP ≥ 60 mmHg ((i.e., no epinephrine or norepinephrine \<0.2μg/kg/min, or equivalent dose vasopressin or phenylephrine) * HR ≤ 140bpm * 35 ≤ BT ≤ 38 ℃ * RR ≤ 35/min 3. Clinical status * resolution of acute disease process * no newly developed pulmonary infiltration * Ramsay sedation score 2\ 4 * Hb \> 7, pH \> 7.30, normal electrolyte * no active bleeding, no IICP, no bronchospasm, no CAD * no rescure or specific treatment (NO, prone, OP plan) * ABGA : pH ≥ 7.43 and HCO3- ≥ 26mEq/L
Exclusion criteria
* Permanent ventilator dependency due to brainstem disease, diffuse cerebral disease, severe respiratory or neuromuscular disease * Active bleeding, IICP, unstable coronary artery disease, bronchospasm, and rescue treatment (inhaled NO, prone), pre-op condition * Contraindication to acetazolamide: renal insufficiency (creatinine clearance \<20 ml/min and/or renal replacement therapy), intolerance or allergy to acetazolamide or sulfonamides, hyperchloremic metabolic acidosis, hyponatremia (Na\<130), hypokalemia (K\<3.5), adrenal insufficiency. * Diaphragm dysfunction : as diagnosed by fluoroscopy, nerve conduction velocity, USG, or overt paradoxical motion of the abdomen
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| weaning time between two group | hour | Weaning time : \[total ventilation time\] - \[total controlled mode time\] |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Successful weaning rate between two group | — | Successful weaning : self respiration more than 48h after withdrawl mechanical ventilation |
| total duration of mechanical ventilation between two group | hour | — |
| length of ICU stay between two group | hour | — |
| frequency of ventilator associated pneumonia between two group | — | — |
| overall ICU mortality between two group | — | — |
Countries
South Korea
Contacts
Primary ContactEun Young Choi, Fellow
Backup ContactChae-Man Lim, professor
Outcome results
None listed