الفهرس 
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Abstract
Acute respiratory distress syndrome (ARDS) is a major cause of acute respiratory failure and it is associated with high mortality and morbidity.
A range of physical methods for the general treatment of respiratory diseases is available. Among these methods, noninvasive ventilation (NIV) is a widely accepted treatment that has been used for diseases such chronic obstructive pulmonary disease exacerbation and cardiogenic pulmonary edema for more than 2 decades.
The advantages of NIV include no requirement for endotracheal intubation, which lowers the risk of ventilator-associated pneumonia, a shorter intensive care unit (ICU) length of stay, and decreased hospitalization costs.
Several studies were performed to compare between using invasive and non-invasive mechanical ventilation in management of patients with ARDS. the overall conclusion can be that using invasive mechanical ventilation is the standard method of management of ARDS, however, using NIV is still controversial and benefits of its use is still a matter of debate especially in severe cases.
The aim of the present study is to evaluate whether using of noninvasive mechanical ventilation can achieve a good improvement in patients with mild ARDS compared to those treated with endotracheal intubation and invasive mechanical ventilation.
Sixty ICU patients who were diagnosed as mild acute respiratory distress syndrome were included in the study. Thirty of them received invasive mechanical ventilation after endotracheal intubation (group 1) , and the other 30 patients received non-invasive mechanical ventilation using CPAP mask (group 2).
The exclusion criteria were; Pregnant female, Immunosuppressant patients, Severe chronic liver disease (class B, C child-paugh score) and renal impairment (creatinine clearance less than 50 ml/ min), Moderate and severe ARDS (Po2/Fio2 <200), Hypotension and shock state (BP less than 90/60 mmHg), No other requirement for emergency intubation and APACHE II score more than 20.
Relevant history was taken, clinical examination was done laboratory investigation as renal, hepatic functions and arterial blood gases were withdrawn at starting of the study as well as radiological investigations as chest x-ray and echocardiography.
Vital signs as blood pressure, heart rate and respiratory rate as well as arterial blood gases and hypoxemic index were monitored hourly, and signs of improvement or failure according to previously defined criteria were recorded.
The study included 40 males (66.6 %) and 20 females (33.3%). group 1 included 18 males (60%) and 12 females (40%), and group 2 included 22 males (73.3%) and 8 females (26.7%).
In group 1 age of subjects ranged from (38-78) years (mean 56.33 ± 11.29), and in group 2 the age of subjects ranged from (20-74) years (mean 50.83 ± 13.76). There was no significant difference between the ages of the subjects of the two groups.
There was a significant difference between the two groups according to the outcome with success rate of ( 93.3 %) for group 1 versus success rate of (73.3%) for group 2 with (p =0.038).
In group (1) the PH ranged from (7.01-7.56) and in group (2) the PH ranged from (7.20-7.59) and the only significant difference between the two groups was during the zero hour.
There were 8 cases who failed to improve in group 2, four of them had metabolic acidosis with PH ≤7.30 and other 2 cases had compensated metabolic acidosis.
Also in our current study we found that younger ages have higher response to treatment and success rate in both groups compared to older ages, as the mean age for patients who failed to improve in group 1 was 69 which was higher than those who improved in the same group where the mean age was 56, also the mean age of patients who failed to improve in group 2 was 66 which was higher than the mean age (45) of patients who improved in the same group.
Till the present day it is well established that invasive mechanical ventilation remains the standard treatment option in management of ARDS especially in moderate to severe cases, however, non-invasive mechanical ventilation may play a significant role in management of selected mild cases in addition to avoidance of endotracheal intubation with its usual problems and risks.
By the end of our study we can state that Noninvasive mechanical ventilation can be a treatment option for patients with mild (ARDS) and may even be the first choice of treatment provided that patients are closely monitored for signs of improvement during the first few hours. However ,patients with mild (ARDS) who are older or with metabolic acidosis respond much less to (NIV).No doubt that further studies are needed for more evaluation with larger sample size and longer follow up.