الفهرس 
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Abstract
Patients with respiratory failure frequently require
endotracheal intubation (ETI) and mechanical ventilation (MV)
to sustain life. While invasive ventilation is effective, it has
been associated with the development of complications
including respiratory muscle weakness, upper airway
pathology, ventilator associated pneumonia (VAP) and
sinusitis. Ventilator associated pneumonia (VAP) is in turn
associated with increased morbidity and a trend toward
increased mortality. For these reasons, minimizing the duration
of invasive mechanical support is an important goal of critical
care medicine.
A balance must be achieved between the risk associated
with early discontinuation and delay in extubation. Premature
withdrawal causes loss of airway protection, cardiovascular
stress, suboptimal gas exchange, muscle overload and fatigue.
Delayed withdrawal exposes to complications associated with
ventilation like infections, barotrauma, stretch injury, sedation,
airway trauma and costs.
Non-invasive ventilation (NIV) can be used to facilitate
weaning (earlier extubation), to prevent re-intubation in postsurgical
respiratory distress, and in patients with respiratory
failure after planned extubation. In the latter instance NIV has
been used immediately after extubation in patients at elevated
risk for extubation failure. On the other hand, NIV has been
applied in patients who developed overt respiratory failure after
extubation, with the goal of avoiding re-intubation.
Summary
129
The aim of this work was to study the impact of non-invasive
ventilation on the outcome of the extubated chronic
hypercapnic patients and comparing it versus conventional
Oxygen therapy in the Respiratory Intensive Care Unit at Ain
Shams University Specialized Hospital during the period from
October 2013 till May 2015.
This is a prospective study which was conducted upon
80 extubated chronic hypercapnic patients admitted to the
respiratory ICU at Ain Shams University specialized hospital.
The included patients were subdivided into two groups:-
group A:-
This group included 40 extubated chronic hypercapnic
patients who were kept on non-invasive ventilation
immediately after removal of the endotracheal Tube.
group B:-
It included 40 extubated chronic hypercapnic patients
who were kept on conventional oxygen therapy after removal
of the endotracheal tube.
Exclusion criteria:
The following patients were excluded from the study:
1. Patients with hemodynamic and/or clinical respiratory
instability.
2. Patients with suspected swallowing disorders.
3. Patients with ineffective cough and\or persistent
bronchial hypersecretion at the time of weaning.
4. Uncooperative patient.
5. Patients with contraindications for the use of a face
mask (skin lesions, facial trauma, facial or skull bone
fracture ± deformities).
Summary
130
6. Recent gastrointestinal surgery.
7. Recent myocardial infarction.
8. Patients with increased intra-cranial tension.
Patients in group (A) and (B) were subjected to the
following:
1.Informed Consent from the patients or their guardians
to be a part of this study before inclusion in the study.
2.History taking including
*Age
*Smoking or addiction history
*Occupational history
*Comorbid illness
3.Thorough clinical examination.
4.Laboratory work up: CBC, Kidney functions tests, Liver
functions, Electrolytes (Sodium, Potassium).
5. Chest X ray.
6. Weaning from mechanical ventilation was done using
the spontaneous breathing trial (SBT) strategywith T-piece or
pressure support ventilation (PSV).
The results of the present study showed thatgroup (A)
included 40 patients; twenty nine (29) of them were males
(72.5%) and eleven (11) were females (27.5%). The mean age
of this group was (57.25±6.54) years old while patients in
group (B) included twenty seven (27) patients of this group
were males (67.5%) and thirteen (13) of them were females
(32.5%). The mean age of this group was (59.15±5.82) years
old.
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131
Also it showed that The cause of hypercapnic respiratory
failure in group (A) was COPD with AE in twenty two (22)
patients (55%), ILD with AE in nine (9) patients (22.5%) and
OHS in nine (9) patients (22.5%), while in group (B), twenty
three (23) patients suffered COPD with AE (57.5%), six (6)
patients were suffering ILD with AE (15%), ten (10) patients
were suffering OHS (25%) and one (1) patient suffered
myasthenia gravis (2.5%).
In this study, it was found that there was statistically
significant difference between both groups regarding the
required FiO2 at the final outcome with (65%) of patients in
group (A) required FiO2 of (24%) versus (57.5%) of patients in
group (B) required FiO2 of (60%).
As regards ABG parameters at the final outcome, the
present study showed statistically significant difference in pH
which was higher in group (A) (7.36±0.05) than that in group
(B) (7.32±0.04), statistically significant difference in PCO2
which was lower in group (A) (59.8±9.16) than that in group
(B) (68.85±7.87). There was statistically significant difference
in PO2 which was higher in group (A) (61.05±4.76) than that
in group (B) (56.22±5.43). Also, there was statistically
significant difference in O2 Saturation which was higher in
group (A) (88.8±6.42) than that in group (B) (83.47±7.51).
The present study showed a statistically significant
difference between both groups regarding the final outcome as
Summary
132
(75%) of patients in group (A) were discharged from the RICU
versus (42.5%) of patients in group (B) while (22.5%) of
patients in group (A) required re-intubation versus (52.5%) in
patients in group (B).
As regards duration from extubation till final outcome (length
of stay in the RICU after extubation), the present study showed
statistically significant difference between both groups with
shorter duration in group (A) (1.6±0.49) than that in group (B)
(6.13±1.79).
The current study showed that in group (A), (88.89%) of
OHV patients were discharged from the RICU followed by
(72.73%) of COPD patients, while in group (B), (50%) of ILD
patients were discharged from the RICU followed by (43.47%)
of COPD patients. This confirms that patients with OHV had
the most significant benefit from the use of NIV after
extubation.
In both groups of this study, there was highly statistically
significant relation between FiO2 and the ABG parameters at
the final outcome (direct relation between FiO2 and PCO2,
negative relation between FiO2 and pH, PO2, O2 Sat. and
HCO3). On the other hand, there wasn’t statistically significant
relation among duration of MV, number of SBT and the ABG
parameters at the final outcome.
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133
Finally, the current study showed that there was
statistically significant relation between the cause of
hypercapnic respiratory failure and the ABG parameters at the
final outcome of patients in both groups. In patients with
COPD, there was statistically significant difference between
both groups regarding pH, PCO2, PO2 and O2 Sat. with the
better values in patients of group A. In patients with ILD, there
was statistically significant difference between both groups
only in PO2 with mean value ± SD (61.44±3.08) in group A
versus (55.5±6.53) in group B. In patients with OHV, there was
statistically significant difference between both groups
regarding pH, PCO2, PO2 and O2 Sat. with the better values in
patients of group A