Background 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. Methods 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. Results 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). Conclusion 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. PROSPERO registration number CRD42021278757.

中文翻译：

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乙酰唑胺治疗代谢性碱中毒并发慢性阻塞性肺疾病或肥胖低通气综合征的呼吸衰竭：系统评价

背景 代谢性碱中毒可能导致慢性呼吸系统疾病患者呼吸抑制，增加通气支持需求或延长通气脱机时间。乙酰唑胺可以减少碱血症，并可能减少呼吸抑制。方法 我们检索了 Medline、EMBASE 和 CENTRAL 从开始到 2022 年 3 月的随机对照试验，比较乙酰唑胺与安慰剂治疗慢性阻塞性肺病、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住院的患者。主要结局是死亡率，我们使用随机效应荟萃分析汇总数据。使用Cochrane RoB 2（偏倚风险2）工具评估偏倚风险，使用I2值和异质性χ2检验评估异质性。使用 GRADE（建议、评估、制定和评价分级）方法评估证据的确定性。结果 纳入了四项研究，涉及 504 名患者。99% 的纳入患者患有慢性阻塞性肺疾病。没有试验招募患有阻塞性睡眠呼吸暂停的患者。50% 的试验招募了需要机械通气的患者。偏倚风险总体较低至一定风险。乙酰唑胺在死亡率（相对风险 0.98（95% CI 0.28 至 3.46）；p=0.95；490 名受试者；三项研究；GRADE 低确定性）或通气支持持续时间（平均差 -0.8 天（95 % CI -7.2 至 5.6）；p=0.36；427 名受试者；两项研究；等级：低确定性）。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影响不大。然而，不能排除临床上显着的益处或危害，需要进行更大规模的试验。PROSPERO 注册号 CRD42021278757。