الفهرس 
MechanicalVentilationOnly 14 pages are availabe for public view
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Abstract
Weaning from mechanical ventilation represents the period of transition from total ventilatory support to spontaneous breathing. The aim of this study is to compare between the efficacy of some predictors (traditional and new) in different weaning modes for successful weaning from mechanical ventilation. We followed a multidisciplinary weaning protocol incorporating daily screening of respiratory function with a trial of spontaneous breathing. After routine laboratory and radiological investigations were done , we followed a 3 steps protocol of weaning including firstly ASSESS READINESS FOR WEANING using daily screening criteria to assess patient’s readiness for weaning, secondly weaning stage including performing a trial of spontaneous breathing and methods of gradual weaning (PSV,SIMV,CPAP and BiPAP), thirdly extubation. The study included hundred patients divided into 4 groups according to the method of weaning: group (1) CPAP (n = 25), group(2) PSV(n = 25), group(3) SIMV(n = 25) and group(4) NPPV(n = 25). The study included 70 males (70%) and 30 females (30%) with males and female ratio for PSV group is (60%, 40%), SIMV group (68%, 32%), CPAP group (76%, 24%) and NPPV group is (76%, 24%) and the mean age of the PSV group is (63.92±7.57), SIMV group is (58.76±9.42), CPAP group is (59.24±5.86) and NPPV group is (62.92±9.23), complicated by type 2 We found that the highest successes rate is in the NPPV group (92%) while the highest failure rate is in the SIMV group (36%). It also shows significant difference in the weaning outcome when comparing: PSV and SIMV groups and SIMV and CPAP groups, while it shows insignificant difference when comparing PSV and CPAP groups and PSV and NPPV groups and SIMV and CPAP groups and CPAP and NPPV groups As regard Po2 during weaning we found that the highest value was in the NIPPV group (94.92±15.14) and the lowest value was in the CPAP group (87.48±9.73) and SIMV groups (92.52±9.77). As regard Pco2 during weaning we found that there is no significant difference when comparing all groups and the four modes were comparable (P value > .05). As regards PH during weaning we found that there is no significant difference when comparing all groups except when comparing SIMV and NPPV groups. So, ABG can be used as a good weaning predictor as it expresses the best value in the NPPV group which shows the best success rate. As regard respiratory rate (RR) during weaning, in our study we found that there is significant difference when comparing all groups except when comparing PSV and NPPV groups and SIMV and CPAP. In our study, regarding RSBI during weaning, we found insignificant difference (P value > .05) when comparing PSV and NPPV groups and SIMV and CPAP, while it shows significant difference when comparing other groups. The highest value was in the CPAP group and the lowest value was in the NPPV group. Regarding CROP index measured during weaning, we found that there is significant difference (P value < .05) as regard CROP index during weaning when comparing PSV and NPPV groups and SIMV and NPPV groups and CPAP and NPPV groups, while it shows insignificant difference when comparing other groups. The highest value was in the CPAP group (13.32±4.49) and the lowest value was in the NIPPV group (8.72±3.63). Regarding CORE index measured during weaning, we found that there is significant difference when comparing all modes except when comparing CPAP and NPPV groups. The highest value was in the PSV group (9.19±8.85) followed by NPPV group (8.46±4.21) and the lowest value was in the CPAP (5.15±2.89). Regarding Integrative weaning index (IWI), we found significant difference (P value < .05) when comparing SIMV and CPAP groups and CPAP and NPPV groups, while it shows insignificant difference when comparing other groups. The highest value was in the CPAP group (23.36±2.27) while the lowest value was in the SIMV group (21.68±2.56). In our study ,we found that there is highly significant difference (P value < 0.001) between patient who succeeded and who failed weaning as regard CORE index and only significant difference regarding RBSI , while there is non significant difference as regard other indices(CROP,IWI). So, Regarding weaning indices the CORE index is better in predicting the weaning outcome than the CROP index, the IWI and the RSBI as its value is better in the NPPV group which express the highest success rate.