الفهرس 
ACUTE RESPIRATORY FAILUREOnly 14 pages are availabe for public view
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Abstract
Introduction: Despite that mechanical ventilation can be withdrawn in the majority of patients after resolution or significant improvement of the underlying indication for mechanical ventilation, it is estimated that around 20-30% of patients will need a gradual withdrawal of ventilatory support. The process of discontinuing mechanical ventilation is a major clinical challenge especially in patients with COPD, consequently, in order to reduce the need for prolonged mechanical ventilation, all measures aimed to decrease weaning period are welcomed
Aim of work: To assess the effectiveness of noninvasive positive pressure ventilation (NPPV) as a recently used weaning technique in comparison to other invasive weaning techniques (IPSV, and SIMV+PS), in patients with acute and/or acute-on-top of chronic respiratory failure needing invasive mechanical ventilation.
Patients and methods: This study was carried out on 67 patients (43 males and, 24 females, with age ranging from 24 to 85 years) with acute or acute-on-top of chronic respiratory failure admitted in Medical Intensive Care Unit of Emergency Hospital and Respiratory Intensive Care Unit of Thoracic Medicine Department, Mansoura university hospital during the period from November 2005 to December 2008. All the 67 eligible patients for this study were weanable with no contraindication for extubation but their first spontaneous breathing trial failed. They were randomized to one of the following groups: Group I (conventional-weaning group), Group II (non-invasive ventilation-weaning group). All selected patients were subjected to thorough history taking, complete clinical examination, detection of any organ system failure or comorbidity, routine laboratory investigations, and arterial blood gases. Recording success or failure, durations of ventilation, weaning and ICU and Hospital length of stay were also done.
Results: The overall success rate in this work reached 82.1%, without significant differences between NPPV group and IPPV group or its subgroups (IPSV or SIMV+PS). Patients in NPPV group were intubated for a significantly shorter duration than patients in IPPV group, or its subgroups (IPSV, and SIMV+PS). The duration of weaning in NPPV group was significantly longer than in IPSV subgroup but similar to IPPV group and SIMV+ PS subgroup. Patients in NPPV group spent a significantly prolonged total duration of ventilation than those in IPPV group or those in IPSV subgroup, but not significantly different than in SIMV subgroup of patients.
Conclusions: The use of NPPV to facilitate weaning, in mechanically ventilated patients, in a group of heterogeneous patients with predominantly chronic obstructive pulmonary disease, presents an alternative effective, method to invasive weaning methods with an equal high success rate and efficient gas exchange in selected cases.