Use of acetazolamide to decrease cerebrospinal fluid production in chronically ventilated patients with ventriculopleural shunts

Acetazolamide (ACTZ), a carbonic anhydrase inhibitor, has been shown to dec rease cerebrospinal fluid (CSF) production in both in vivo and in vitro ani mal models. We report two children with hydrocephalus who experienced multi ple shunt failures, and who had externalised ventriculostomy drains (EVD) p rior to ventriculopleural shunt placement. The effects of increasing doses of ACTZ on CSF production and subsequent tolerance to ventriculopleural shu nts were evaluated. The patients had a 48% and a 39% decrease in their EVD CSF output when compared to baseline with maximum ACTZ dose of 75 mg/kg/day and 50 mg/kg/day, respectively (p < 0.05). This is the first report of cha nge in CSF volume in children after extended treatment with ACTZ. ACTZ trea tment in mechanically ventilated paediatric patients with hydrocephalus may improve tolerance of ventriculopleural shunts and minimise respiratory com promise. Potassium and bicarbonate supplements are required to correct meta bolic disturbances.