الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Noninvasive ventilation (NIV) has been established as a useful and safe method to improve gas exchange for critically ill patients with different etiologies of acute respiratory failure (ARF).
NIV decreases work of breathing, improves arterial oxygenation and alveolar ventilation, prevents the use of invasive mechanical ventilation.
The study investigates the benefits of the Non invasive ventilation in management of acute respiratory failure of different aetiologies, and the significance of the NIV in early extubation or in management of prolonged weaning in COPD patients.
In this study, 103 adult patients presented with acute respiratory failure consecutively admitted to Respiratory Intensive Care Unit (R.I.C.U.) of Chest Diseases Department, Assiut University Hospital.
Within the constraints of a prospective observational study, we report a good success rate for NIV, NIV was successful in 68.93% of patients in our study. The acute hypercapnic patients formed a significant (90%, n = 93) proportion of patients in our study. Of these, 57 patients were diagnosed to have COPD, the success rate was 69.89% in hypercapnic (type II) ARF.
The success or failure of NIV in the current study has no significant relation to the age of study patients, presence of comorbid condition and history of previous ICU admission.
In the current study, over the 2hrs, 24-48 hours of follow up after NIV, significant improvement was observed clinically and in gasometric parameters. The optimum cut off level below which failure was predicted was a PH value of 7.22.
The NIV failure rate in the present study was (31.07%), (17.48%) were Late failure after more than 48hrs of NIV.
The causes of Failure respectively were; disturbed consciousness, excessive secretions, and hemodynamically instability.
The application of NIV resulted in shorter mean duration of mechanichal ventilation, shorter length of ICU stay, fewer complications and decreased mortality and was well tolerated in our patients.
The present study included in its studied population n= 19 patients presented with respiratory failure of various etiologies mostly COPD n=15 of 19 requiring invasive mechanical ventilation initially and weaned. in which NIV was needed post extubation preventing re-intubation in 11 patients who show success of application of postextubation NIV.
Conclusion
• The use of noninvasive ventilation (NIV) in patients with acute respiratory failure has shown to be effective in the relief of dyspnea, the improvement of vital signs and gas exchange, in preventing endotracheal intubation, and improving overall survival.
• Monitoring of patients closely is necessary to evaluate treatment responsiveness and to facilitate endotracheal intubation if NIV failed.
• There are predicted parameters of NIV failure that may change during the application of NIV.
• A satisfactory initial NIV attempt is not always a marker of a good outcome. Late NIV failure occur in 17% of patients in whom the initial NIV attempt was satisfactory.
• Application of non invasive ventilation could be effective in limiting the need for re-intubation and decrease mortality in extubated patients with respiratory failure.
RECOMMENDATION
- It is recommended that the physicians including resident doctors and nurses on duty managing patients of acute respiratory failure on NIPPV should be observant about the changes in the patients HR, RR, pH, and PCO2 at first to two hours and subsequently, so that patients requiring invasive ventilation may be intubated at the earliest to prevent avoidable increase in morbidity and mortality.
- Newer modalities of treatment such as NIPPV require trained staff that can not only introduce and implement such therapies but also enable such treatments to translate to improvements in patient and clinical outcomes.