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Abstract: FR-PO297

Carbonic anhydrase Inhibitors (CAI) Use in Patients with Respiratory Failure and Metabolic Alkalosis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Session Information

Category: Fluid and Electrolytes

  • 902 Fluid and Electrolytes: Clinical

Authors

  • Tanios, Bassem Y., American University of Beirut Medical Center, Beirut, Lebanon
  • Omran, Maryam Omar, American University of Beirut Medical Center, Beirut, Lebanon
  • Noujeim, Carlos, American Universtiy of Beirut Medical Center, Beirut, Lebanon
  • Lotfi, Tamara, American University of Beirut, Beirut, Lebanon
  • Mallat, Samir G., American University of Beirut Medical Center, Beirut, Lebanon
  • Boukhalil, Pierre K., American Universtiy of Beirut Medical Center, Beirut, Lebanon
  • Akl, Elie A., American University of Beirut Medical Center, Beirut, Lebanon
  • Itani, Houssam Samir, Makassed General Hospital, Beirut, Lebanon
Background

Metabolic alkalosis is common in patients with respiratory failure and may delay weaning in mechanically ventilated patients.The objective of this systematic review is to assess the benefits and harms of CAI therapy in patients with respiratory failure and metabolic alkalosis

Methods

We conducted a comprehensive literature search for relevant randomized clinical trials(RCTs) assessing at least one of the following outcomes:mortality,duration of hospital stay,duration of mechanical ventilation(MV),blood gas parameters,and adverse events.Teams of two review authors independently and in duplicate selected eligible trials then abstracted data,and assessed risk of bias of the included trials.The primary meta-analysis used a random-effects model

Results

We identified 6 eligible RCTs with a total of 564 participants.The synthesized data did not exclude neither a reduction or an increase in mortality or in duration of hospital stay with the use of CAI(Table).There was a decrease in the duration of MV of 27(95% CI -50; -4) hours with CAI use(Figure).CAI therapy resulted in an increase in PaO2,and a decrease in PaCO2,serum bicarbonate and pH.There was an increased risk of adverse events in the CAI group(Table).Quality of evidence was judged to be low for most outcomes

Conclusion

In patients with respiratory failure and metabolic alkalosis,results of our systematic review suggest that CAI therapy has a favorable effect on blood gas parameters.In mechanically ventilated patients,the evidence suggests that CAI therapy may decrease duration of MV.Therefore,this clinically important outcome should be confirmed by future larger RCTs

OutcomeNumber of studiesNumber of ParticipantsStatistical MethodEffect Estimate
Mortality2427Risk Ratio (M-H, Random, 95% CI)0.94 [0.57, 1.56]
Duration of Hospital Stay
(Days)
2117Mean Difference (IV, Random, 95% CI)0.42 [-4.82, 5.66]
PaCO2
(mmHg)
5185Mean Difference (IV, Random, 95% CI)-4.98 [-9.66, -0.30]
PaO2
(mmHg)
3118Mean Difference (IV, Random, 95% CI)11.37 [4.18, 18.56]
Serum Bicarbonate
(meq/L)
267Mean Difference (IV, Random, 95% CI)-5.03 [-6.52, -3.54]
pH4165Mean Difference (IV, Random, 95% CI)-0.04 [-0.07, -0.01]
Adverse Events5508Risk Ratio (M-H, Random, 95% CI)1.71 [0.98, 2.99]