الفهرس 
Non-invasive mechanical ventilationOnly 14 pages are availabe for public view
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Abstract
Design: Prospective, controlled study. Setting: Intensive care unit of Mansoura Emergency Hospital and Chest Department. Patients: This study was carried out on 140 COPD patients with ARF from June 1999 to July 2002. Intervention: Patients were randomized into 2 main groups: control group (40 patients) received only standard medical treatment, and NIPPV group (100 patients) received NIPPV plus standard medical treatment. Measurements: All cases were subjected to thorough history taking (with special attention to age, sex, premorbid life-style score, and previous intubation) and clinical examination (with special attention to the cause of exacerbation). Assessment of vital signs (RR, HR, MAP) and ABGs (pH, PaCO2, PaO2) were done during the 1st 12 hs of the study. While the APACHE II score, GCS and serum albumin level were assessed during 1st 3 days of the study. Detection of associated MOF and complications associated with NIPPV were done. The need for ETI and length of ICU stay were evaluated as an early outcome. Main results: The present study found that the use of NIPPV was associated with decrease incidence of ETI and length of ICU stay. Univariate analysis showed that the old age, prolonged duration of NIPPV, presence of pneumonia as cause of exacerbation, higher premorbid life-style score, increased number of previous ETI, and the presence of associated MOF were important bad prognostic factors for survival. Also, higher APACHE II score, lower GCS, lower serum albumin levels, and the use of higher pressure support levels were another bad prognostic factors. While the decrease in RR, HR, PaCO2 and the increase in pH, PaO2 on admission and in the 1st 12hs of study were a good prognostic factors for survival. Conclusion: Early application of NIPPV in treatment of COPD patients with ARF will reduce the need for ETI and decrease the duration of ICU stay. The best predictor for survival was the GCS on admission with the overall predictability of the outcome predictive equation was 98%. Abbreviations: MAP: Mean arterial pressure, ABG: Arterial blood gases, PaCO2: Arterial carbon dioxide tension, PaO2: Arterial oxygen tension, APACHE: Acute physiology and chronic health evaluation, GCS: Glasgow coma score, MOF: Multiple organ failure, ETI: Endotracheal intubation, ICU: Intensive care unit.