الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 141 |  |  |
| | | from | 141 | | |
Abstract
The present study included109 patients with AHRF who were admitted to the respiratory ,general ,surgical ICU at Beni- Seuf University hospital in the period from March 2017to September 2018 and met the inclusion criteria.
The aim of this work is to assess the effectiveness of non-invasive ventilation (NIV) in patients with acute hypoxemic respiratory failure comparing it with the standard oxygen therapy using venturi and non rebreathing oxygen mask and Searching for predictors of failure of NIV.
The included patients had different etiology for AHRF :ARDS,
• Pneumonia,• Asthma exacerbation • Interstitial lung disease exacerbation •Pulmonary embolism: •Pulmonary contusion : •Chest infiltrates in patient with malignancy: •Respiratory failure due to neuromascular affection especially guillain –barre syndrome :•Post operative respiratory failure
The included patients were randomly assigned in a 1:1 ratio, to one of the following strategies as an initial therapy :group I using Standard high flow oxygen therapy with venturi or non rebreathing mask , group II using noninvasive ventilation (ICU NIV )
The baseline characteristics of the two groups was chosen to be as possible similar regarding age, sex, blood gases, RR, and APACHE II score but SAPS2 was higher in NIV group.
Treatment for underlying cause of respiratory failure was done according to the standard guidelines for both groups.
The following were done for all patients:
-Through history taking from patients or relatives.
-Full clinical examination.
-Chest radiology: Plain chest x ray and CT chest CT pulmonary angiography when indicated.
-Routine labs.(CBC , Cr ,BUN, serum Na and K ,bilirubin)
-Culture for sputum or blood cultures when indicated.
-Any other investigation needed according to cause of AHRF were done.
Patients in the current study were divided into 2 groups for the management of their hypoxic state ,group I 51 patients received high flow oxygen therapy and group II 58 patients received NIV .
Comparing the two groupsThere was no big difference regarding their baseline initial characteristics as mean age of NIV group was slightly higher than oxygen group 60.3 vs 58.1 with no significant difference (p value .468) and most of NIV group were male 66%.
Regarding oxygen status PO2/FIO2 ratio was higher in oxygen group Concerning causes of AHRF, percent of Patients with ARDS, pneumonia ,neuromuscular disease were higher in NIV group than oxygen therapy group but other etiologies infiltration with malignancy ,pulmonary embolism , lung contusion were higher in group I received conventional oxygen therapy .
There was no statistical difference regarding Vital signs : SBP , DBP, HR .,RR in both groups but regarding physiologic scores mean of SAPS2 and APACHE score were higher with statically significant difference in NIV group ‘
Co- morbidities were higher in NIV group (renal insufficient ,liver cirrhosis and DM)
Regarding primary outcome (rate of intubation) in the current study it was found NIV decrease rate of intubation as in this NIV group the rate of intubation was 55% versus to 70.5% in group I oxygen therapy group with and the most common cause of intubation in oxygen therapy group was DCL and refractory hypoxemia and most common cause in NIV group was DCL followed by refractory hypoxemia and muscle fatigue
NIV use decrease ICU and hospital stay .and Complication it was lower with NIV as it was (24% ) only VS 47% in oxygen therapy even the complication in NIV group was not severe, gastric distention and mild nasal bride injury 8.6% each but the severe complication was low as cardiac arrest 5.1% and HAP zero percent while complication with oxygen therapy group was more severe as cardiac arrest 62.5% , HAP 8.3%
Mortality was higher in NIV group the majority from ARDS patients ,and in pneumonia patients mortality
In Postoperative and asthma patients no mortality in both studded group, pul. embolism and ILD exacerbation showed no mortality with NIV and very low percent with oxygen therapy .
58 patients who received NIV , (44.8%) of them succeed and not need intubation and (55.1%) failed and need intubation accordingly we divided group II NIV patients into 2 subgroups(group IIA success NIV 26 ) and (group IIB failure NIV 32 )
Comparing between them regarding baseline characteristics found that mean age was younger in group IIA, regarding cause of AHRF all patients that has ARDS and malignant infiltration and neuromuscular affection fail in NIV , The main factors associated with success or failure were the etiology of respiratory insufficiency and the presence of dysfunction of other organs besides the lungs
In our study, only 9 of our patients who had the diagnosis ARDS and received NIV with failure rate 100 %..All cases of ILD exacerbation and postoperative received NIV had 100% success
Regarding Asthma exacerbation in our study 2/5 patients ( 40 %) and represent 2/26 of succeeded cases
In our study, community-acquired pneumonia was the main reason for NIV use 22 /58 .Intubation was avoided in (12 /22 ) 54 % of pneumonia patients which represent ( 46 %of success case .12/ 26)
Patients who failed NIV their mean base line on admission RR and their physiological score SAPS 2 and APACHE2were higher with high significant p value. Their PO2/FIO2 ratio was lower (211 VS263 )with significant p value
Regarding underlying comorbidity it was higher in group IIB(75% VS 15% p value >.0001)
Patients who succeeded NIV their mean duration on NIV was longer ( mean 9 days VS 3 days p value <.0001
The success group their ICU stay and hospital stay was shorter than failure NIV (9 VS 16 ) and (13 VS 22)with significant p value
Failure NIV group, the complication and mortality was higher (34% , 56% respectively ) while in succeeded group lesser complication and no mortality .
.
In the current study Univariate logistic regression analysis was performed to assess the factors associated with NIV failure and found that underlying immunosuppressive, ARDS, underlying malignancy ,high SAPS2>33 and APACHE2 >25score baseline PO2/FIO2 <211 were predictors of failure NIV, follow up of respiratory rate , ABG after one hour and four hour was a good predictors of NIV outcomes
So patients should be carefully monitored during the NIV trial for early prediction of NIV failure
Limitations. Of our study This was a single center study and it included a small number of patients.all patients were ventilated using only one type of interface( naso –oral mask)