COPD: exacerbation: doxapram had no clear effect in preventing deterioration in acute respiratory failure

Clinical bottom line (level 1a-)

  1. Patients with COPD and respiratory failure who receive doxapram were not clearly more likely to avoid a deterioration in blood gases or require intubation and ventilation.
Greenstone : Cochrane Library 1999; 3: -
Expires November 2003

The study

Systematic review of all randomised controlled trials of
  • Patients: with acute exacerbations of COPD
  • Intervention: intravenous doxapram compared with no doxapram
  • Outcome: blood gas, progression to endotracheal intubation and ventilation, mortality, length of hospital stay


    • Articles found in all languages using Cochrane Airways Group COPD RCT register (containing Medline, CINAHK, EMbase), (search terms: doxapram ) and hand-searching journal and abstracts. The bibliographies were searched for additional papers and original authors and pharmaceutical companies were contacted to identify additional studies.

    Selection criteria: see above
    Appraisal criteria: concentrating on allocation concealment: performed by one reviewer
    Articles excluded if:
    • patients not spontaneously breathing or receiving general anaesthesia


    3 RCTs found involving 127 patients.
    The studies were found to be heterogeneous for disease severity. Data was incomplete in some cases.

    The evidence

    Outcome Time to outcome CER OR
    (95% CI)    		 NNT
    (95% CI)
    deterioration in blood gases 2 hours 14/38
    (36.84%)    		 0.38
    (0.14 to 1.02)     		-5
    (NNT = 216 to infinity;
    NNH = 3 to infinity)
    intubation and ventilation required 2 hours 12/38
    (31.58%)    		 1.29
    (0.51 to 3.27)     		-17
    (NNT = 7 to infinity;
    NNH = 4 to infinity)

    • A small study of 17 patients comparing doxapram and non-invasive ventilation showed no clear difference between the two therapies.

    Citation

    1. Greenstone M, : Doxapram for ventilatory failure due to exacerbations of chronic obstructive pulmonary disease (Cochrane Review): Oxford Update Software. Cochrane Library 1999; 3: -
    Search Terms: COPD or COLD or COAD near exacerbation in Cochrane
    Contributor: Chris Ball and Musab Hayatli, November 1999
    Reviewer: Chris van Weel

    Clinical Question.
    Patient COPD and respiratory failure
    Intervention or Exposure doxapram
    Outcome respiratory failure