الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
The percentage of pediatric patients requiring MV and hospitalized in ICU varies between 30% and 64% worldwide. Invasive ventilation is effective but it has been associated with the development of complications including respiratory muscle weakness, upper airway pathology, ventilator associated pneumonia and sinusitis. Non invasive ventilation is the delivery of MV without an endotracheal tube or tracheostomy, it is increasingly used in PICUs. NIV provides an alternative method of supporting a patient’s respiration by using positive pressure ventilation with either an oronasal, nasal, or total face mask at the patient-ventilator interface. In addition, NIV has been shown to reduce complications related to intubation, especially ventilator associated pneumonia. Also, NIV is used for premature weaning and post-extubation respiratory failure and positive results on reintubation and duration of intensive care unit stay is reported. This is a prospective randomized controlled clinical study carried out at the PICU of Assiut University Children Hospital (A 12-bed tertiary-care unit) on pediatric patients (aged from 1 month to 18 years) presented with respiratory failure and connected to invasive mechanical ventilation during the period from January 2017 till December 2019. The objective of our study was to compare the rates of acute respiratory failure, reintubation and length of intensive care stay after extubation in those using non-invasive mechanical ventilation will be applied instead of routine oxygen face mask application after successful weaning. So, a total of 110 pediatric patients were included, they were divided to two equal groups: group (I): Oxygen mask (n=55): Patients who received oxygen by mask group (II): NIMV (n=55): Patients who received non invasive mechanical ventilation. The results showed that both groups were almost homogenised with no significant differences between them regarding age, gender and weight. The total days consumed before disconnection of ventilation did not differ significantly between groups (p=0.56). While, the mean ICU stay period after disconnection of ventilation was significantly shorter in NIMV group compared to oxygen mask group. Regarding oxygen saturation, no significant differences were found between groups at different follow-up intervals except at 48 hrs. However there was an obvious improvement in oxygen saturation through the time in NIMV group only. The number of cases with normal RR was higher in NIMV group compared to oxygen mask group and a significant improvement in RR was noticed in NIMV group just after 1 hour and continued at all follow up intervals compared to the immediate value while, the significant improvement was started at 24 hrs. in oxygen mask group and continued to 48 hrs. There was a slight improvement in heart rate in cases of group (II) compared to group and a significant improvement in HR was observed early in NIMV group compared to oxygen mask group (at 3 hrs. vs. at 12 hrs.). While, no significant differences were observed between the two groups regarding blood pressure, skin colour and mental status at all follow up intervals. It was observed that oxygen mask group (group I) had significantly higher number of cases needing reconnection to ventilator compared to NIMV group (group II). Regarding causes of reconnection, 6 cases in group (I) vs. 2 cases in group (II) had respiratory causes, 4 cases in group (I) vs. 1 case in group (II) had neurologic causes while, 2 cases in group (I) vs. 1 case in group (II) had multi-system affection. No significant difference in all laboratory tests and blood gases between both groups. The use of NIMV in pediatrics is considered as a new era but with the advancement in its technology, modes, parameters and methods of patient’s interface it achieves a golden role in pediatrics. It is a feasible and safe technique of ventilatory assistance. Use of NIMV decrease the length of hospital stay , risk of invasive ventilation reconnection and the frequency of respiratory failure after extubation even if the patient is regarded as ‘successfully weaned’. NIMV helps many patients with severe lung pathology to be weaned from the invasive ventilation and it can help many patients with multiple organ failure in early termination of invasive ventilation. So the use of NIMV is to be recommended in such patients to avoid unexpected ventilator failure. Also, the hope is to use NIV on widespread scale to be the first choice before invasive ventilation and to be the method of choice in weaning from invasive ventilation. This study has some limitations. Of these, the enrolment of patients for each group might have contributed to selection bias. Further larger studies with longer follow-up are needed to support our findings.