الفهرس 
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Abstract
Real-time pulmonary graphics allow breath-to-breath assessment of pulmonary mechanics and patient-ventilator interaction. It allows the clinician to customize ventilator settings based on patho-physiology and patient response, and may enable detection of respiratory complications before they become clinically apparent. Graphics also provide objective information about the efficacy of pharmacologic agents and changes in patient status over time.
Aim of the work:
That study aimed to evaluate the role of ventilator graphics on modification of ventilatory support and to determine the effect of such modification on mechanics of respiration after mechanical ventilation for hypercapnic respiratory failure.
Patient and methods:
After ethical committee approval and informed consent from patients or their relatives, prospective randomized controlled study had been carried out in intensive care unit, Sohag university hospital. That study included 60 patients suffering from hypercapnic respiratory failure admitted to ICU, in the period from June 2011 to April 2013.
Methods:
The Patients were randomly assigned to study or control group in an alternation fashion at the time of admission, each group included 30 patients.
Groups of the study:
The Patients were randomly assigned to study or control group in an alternation fashion at the time of admission. Each group included 30 patients.
Control group; modification by the conventional ventilatory settings (without using the ventilator graphics).
Study group; modification according to the ventilator graphics.
For the control group:
• Patients of the control group had been ventilated with initial ventilator settings that adjusted according to the conventional ventilatory method.
• Follow up and adjustment of the patients’ respiratory mechanics with the use of numerical data on the ventilator display which were PIP, Pplat, PEEP, exhaled tidal volume, RR, inspiratory flow.
For the study group:
• Patients of the study group were initially ventilated with the conventional ventilatory settings and then managed with ventilatory settings adjusted according to the feedback from the airway graphics as follows.
• Follow up of the patients’ respiratory mechanics according to the findings present in the ventilator graphics;
• flow-time curve
pressure-time curves
flow -volume loop
Pressure -volume loop
Target data collected:
The respiratory mechanics in both groups were obtained (under deep sedation) at 0 hr or baseline values (after initiation of mechanical ventilation and stabilization of the patient) and at 2 hrs, 4hrs, 6hrs, 8hrs, 12 hrs and 24hrs.
I- Respiratory mechanic measurements:
1. Work of breathing (WOB) (Kg. m/min)
2. Respiratory airway resistance Raw (cmH2O/L/sec)
3. Dynamic Compliance (Cdyn) (ml/cmH2O)
4. Static Compliance (Cstat) (ml/cmH2O)
II-Auto-PEEP measurement
Statistical analysis:
Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS). Data were presented as mean ± SD, numbers and percentages. Comparisons were made between the baseline data and the post admission data within the two groups and between the two groups. Level of significance was considered at p < 0.05.
Results:
A total of 60 patients were included in this study and classified into two groups; 30 patients in each group.
The adjustment of ventilator setting using the ventilator graphics (study group) wasn’t significantly different than the adjustment using the conventional settings (control group).
WOB and resistance of the study group were less than that of the control group. Dynamic and static compliance was better in study group than the control group
Conclusion: ventilator waveforms were important in optimizing ventilator settings in mechanically ventilated patients with hypercapnic respiratory failure.
However, the lung mechanics (WOB, resistance, dynamic and static compliance) measured after adjustment of ventilator setting using the graphics (study group) weren’t significantly different than that measured after adjustment using the conventional settings (control group), the lung mechanics were better in the study group than the control group.