الفهرس 
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Abstract
This study included 119 COPD patients who suffered from respiratory failure secondary to acute exacerbation of COPD and who were managed by NIPPV. All patients were admitted to chest department, Minia university hospital during the period from August 2014 till july2016.
The main aim of our study was to evaluate the effectiveness of NIPPV in reducing the need of endotracheal intubation. For all patients the following were done Blood gases analysis values at the admission, at initiation of NIPPV, 2 hours after NIPPV institution and at the time of RICU discharge (success group) or prior to intubation or death (failure group), The mean age of the patients was 62.2±9.64 and 69.7% of the studied patients were male. About 46% of the patients were current smoker, about 30% were lifelong nonsmoker. The most common comorbidities encountered in our patients group were core pulmonale, followed by anemia and CHF comes third.
Seven patients, about (6 %) of the patients deteriorated while they were managed by NIV and require intubation
On comparing the failure and the success group regarding the patient’s demographics, there was significant statistical difference between the two groups regarding patient’s age ,there was statistically significant difference between the two groups regarding mortality, baseline GCS and APACHII scores and the duration of hospitalization.
There was no statistically significant difference in ABGs values at time of hospital admission between the two groups
In the failure group white blood cells were significantly higher while HB concentration was significantly lower. Albumin was significantly lower in the failure group. Base line urea and creatinine was significantly higher in the failure group
As regard the comorbidities there was statistically significant difference between the two groups of patients with renal and those with liver diseases. Other comorbidities showed no statistically significant difference .
Univariate analysis of different parameters showed significant statistical difference between the two groups regarding: age>65, PH<7.26, PaCO2≥50, RR≥35 and WBC≥20,000 or <4000 table
Multivariate analysis showed significant difference with age>65, PH <7.6, RR≥35 and WBC≥20,000 or <4000 table
Significant statistical difference exist between the two groups through the time course of the study regarding RR, HR, SBP & the DBP
Significant statistical difference exist between the two groups at time of NIPPV initiation, one hours later and at NIPPV discontinuation when looking at patient’s temperature.
The failure group had a significant longer hospital stay than the successful group
Complications of NIPPV in the studied group
Failure of NIPPV was present in 5.9%, mask related discomfort was the most frequent encountered complication it was present in 26%% of patients. Mask related ulcer was present in 9.2%, Abdominal distension was present in 4(3.4%), Mask intolerance was present in 3 (2.5% and pneumonia was present in one patient (0.8%).