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In Reply Dr Contou and colleagues underline the importance of monitoring fluid management, especially in patients with COPD.1 They correctly indicate that acetazolamide has a weak natriuretic effect.2 Loop diuretics may be required while attempting to discontinue mechanical ventilation.3 In the DIABOLO trial, the 2 treatment groups did not differ regarding the use of loop diuretics (median, 1; range, 0 to 4 days for the acetazolamide group vs median, 1; range, 0 to 4 days for the placebo group; P = .55). Moreover, left ventricular ejection fraction did not differ between groups at the time of weaning (median, 55%; range, 40%-60% for the acetazolamide group vs median, 50%; range, 42%-60% for the placebo group; P = .86). Weaning failure due to left ventricular insufficiency occurred in 8 patients (4.3%) in the acetazolamide group and 6 patients (3.1%) in the placebo group (P = .41), indicating a conservative approach regarding fluid management. An accurate estimation of body water composition remains challenging in critically ill patients.4
Faisy C, Heming N, . Acetazolamide and Invasive Mechanical Ventilation for Patients With COPD—Reply. JAMA. 2016;316(1):100-101. doi:10.1001/jama.2016.4625