الفهرس 
Chronic obstructive pulmonary disease (COPD)Only 14 pages are availabe for public view
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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 present study was conducted on 40 COPD patients admitted to the intensive care with ARF and required MV. They were divided into two groups. 20 patients were randomly weaned by the T-piece method while the other 20 patients were weaned by PSV.
The aim of this thesis was to evaluate the influence of either method on weaning outcome as well as to detect the factors that can predict or affect the outcome of the weaning process. It was found that there is no statistical significant difference between the effect of either T-piece or PSV method neither on weaning outcome nor on spontaneous tidal volume, respiratory rate or rapid shallow breathing index.
Concerning weaning outcome, there was a significant difference between both groups (success and failure of weaning) as regards serum protein, spontaneous tidal volume, duration of MV, respiratory rate and rapid shallow breathing index. whereas, there was no difference as regards patient’s age, arterial blood gas (ABGs) before MV, serum potassium (S.K+) and total hemoglobin percentage (Hb %).
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.