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Abstract
Despite of the several techniques that had been developed to facilitate discontinuation of MV, weaning remains a great challenge for the physician and the method by which it is accomplished remains controversial among critical-care practitioners particularly in difficult-to-wean patients such as those with chronic obstructive pulmonary disease (COPD).
The aim of this thesis was to compare the outcome of three methods of weaning (pressure support, synchronized intermittent mandatory ventilation and T-piece trials) in mechanically ventilated chronic obstructed pulmonary disease patients with respiratory failure. It was found that there is no statistical significant difference between the three groups regarding weaning outcome.
The present study was conducted on 45 COPD patients admitted to the intensive care with ARF and required MV. The 1st group of (15) COPD patients were randomly selected for weaning by the (T-piece) method while the 2nd group of (15) COPD patients were also randomly selected to be weaned by the (PSV) mode, and finally the 3rd group also randomly selected to be weaned by the (SIMV (VC)/PS) mode.
In this study, there was no statistically significant difference between the three groups regarding age, sex, blood gas (ABGs) before MV, and blood gases, RR, pulse, blood pressure during weaning , and after extubation.
Also, there was no statistically significant difference between the three groups regarding duration on M.V before the weaning. whereas, there was a highly significant difference between the three groups as regards time on weaning mode and there was highly significant difference between successful and failure group as regards RSBI (was measured during weaning by PS mode).
It is sometimes thought that the simple act of connecting a patient to a ventilator will decrease respiratory effort. Yet unless the settings are carefully selected, mechanical ventilation can actually do the opposite and interfere with weaning process, for that we suggest:
o A low respiratory rate 10-12 cycles/min and a I:E ratio of 1: 2.5 or 1: 3 should be chosen to avoid an auto-PEEP.
o Low volume or lung protective ventilation is now recommended for all patients with acute respiratory failure in order to minimize VALI.