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Abstract Patients with respiratory failure frequently require endotracheal intubation (ETI) and mechanical ventilation (MV) to sustain life. While invasive ventilation is effective, it has been associated with the development of complications including respiratory muscle weakness, upper airway pathology, ventilator associated pneumonia (VAP) and sinusitis. Ventilator associated pneumonia (VAP) is in turn associated with increased morbidity and a trend toward increased mortality. For these reasons, minimizing the duration of invasive mechanical support is an important goal of critical care medicine. A balance must be achieved between the risk associated with early discontinuation and delay in extubation. Premature withdrawal causes loss of airway protection, cardiovascular stress, suboptimal gas exchange, muscle overload and fatigue. Delayed withdrawal exposes to complications associated with ventilation like infections, barotrauma, stretch injury, sedation, airway trauma and costs. Non-invasive ventilation (NIV) can be used to facilitate weaning (earlier extubation), to prevent re-intubation in postsurgical respiratory distress, and in patients with respiratory failure after planned extubation. In the latter instance NIV has been used immediately after extubation in patients at elevated risk for extubation failure. On the other hand, NIV has been applied in patients who developed overt respiratory failure after extubation, with the goal of avoiding re-intubation. Summary 129 The aim of this work was to study the impact of non-invasive ventilation on the outcome of the extubated chronic hypercapnic patients and comparing it versus conventional Oxygen therapy in the Respiratory Intensive Care Unit at Ain Shams University Specialized Hospital during the period from October 2013 till May 2015. This is a prospective study which was conducted upon 80 extubated chronic hypercapnic patients admitted to the respiratory ICU at Ain Shams University specialized hospital. The included patients were subdivided into two groups:- group A:- This group included 40 extubated chronic hypercapnic patients who were kept on non-invasive ventilation immediately after removal of the endotracheal Tube. group B:- It included 40 extubated chronic hypercapnic patients who were kept on conventional oxygen therapy after removal of the endotracheal tube. Exclusion criteria: The following patients were excluded from the study: 1. Patients with hemodynamic and/or clinical respiratory instability. 2. Patients with suspected swallowing disorders. 3. Patients with ineffective cough and\or persistent bronchial hypersecretion at the time of weaning. 4. Uncooperative patient. 5. Patients with contraindications for the use of a face mask (skin lesions, facial trauma, facial or skull bone fracture ± deformities). Summary 130 6. Recent gastrointestinal surgery. 7. Recent myocardial infarction. 8. Patients with increased intra-cranial tension. Patients in group (A) and (B) were subjected to the following: 1.Informed Consent from the patients or their guardians to be a part of this study before inclusion in the study. 2.History taking including *Age *Smoking or addiction history *Occupational history *Comorbid illness 3.Thorough clinical examination. 4.Laboratory work up: CBC, Kidney functions tests, Liver functions, Electrolytes (Sodium, Potassium). 5. Chest X ray. 6. Weaning from mechanical ventilation was done using the spontaneous breathing trial (SBT) strategywith T-piece or pressure support ventilation (PSV). The results of the present study showed thatgroup (A) included 40 patients; twenty nine (29) of them were males (72.5%) and eleven (11) were females (27.5%). The mean age of this group was (57.25±6.54) years old while patients in group (B) included twenty seven (27) patients of this group were males (67.5%) and thirteen (13) of them were females (32.5%). The mean age of this group was (59.15±5.82) years old. Summary 131 Also it showed that The cause of hypercapnic respiratory failure in group (A) was COPD with AE in twenty two (22) patients (55%), ILD with AE in nine (9) patients (22.5%) and OHS in nine (9) patients (22.5%), while in group (B), twenty three (23) patients suffered COPD with AE (57.5%), six (6) patients were suffering ILD with AE (15%), ten (10) patients were suffering OHS (25%) and one (1) patient suffered myasthenia gravis (2.5%). In this study, it was found that there was statistically significant difference between both groups regarding the required FiO2 at the final outcome with (65%) of patients in group (A) required FiO2 of (24%) versus (57.5%) of patients in group (B) required FiO2 of (60%). As regards ABG parameters at the final outcome, the present study showed statistically significant difference in pH which was higher in group (A) (7.36±0.05) than that in group (B) (7.32±0.04), statistically significant difference in PCO2 which was lower in group (A) (59.8±9.16) than that in group (B) (68.85±7.87). There was statistically significant difference in PO2 which was higher in group (A) (61.05±4.76) than that in group (B) (56.22±5.43). Also, there was statistically significant difference in O2 Saturation which was higher in group (A) (88.8±6.42) than that in group (B) (83.47±7.51). The present study showed a statistically significant difference between both groups regarding the final outcome as Summary 132 (75%) of patients in group (A) were discharged from the RICU versus (42.5%) of patients in group (B) while (22.5%) of patients in group (A) required re-intubation versus (52.5%) in patients in group (B). As regards duration from extubation till final outcome (length of stay in the RICU after extubation), the present study showed statistically significant difference between both groups with shorter duration in group (A) (1.6±0.49) than that in group (B) (6.13±1.79). The current study showed that in group (A), (88.89%) of OHV patients were discharged from the RICU followed by (72.73%) of COPD patients, while in group (B), (50%) of ILD patients were discharged from the RICU followed by (43.47%) of COPD patients. This confirms that patients with OHV had the most significant benefit from the use of NIV after extubation. In both groups of this study, there was highly statistically significant relation between FiO2 and the ABG parameters at the final outcome (direct relation between FiO2 and PCO2, negative relation between FiO2 and pH, PO2, O2 Sat. and HCO3). On the other hand, there wasn’t statistically significant relation among duration of MV, number of SBT and the ABG parameters at the final outcome. Summary 133 Finally, the current study showed that there was statistically significant relation between the cause of hypercapnic respiratory failure and the ABG parameters at the final outcome of patients in both groups. In patients with COPD, there was statistically significant difference between both groups regarding pH, PCO2, PO2 and O2 Sat. with the better values in patients of group A. In patients with ILD, there was statistically significant difference between both groups only in PO2 with mean value ± SD (61.44±3.08) in group A versus (55.5±6.53) in group B. In patients with OHV, there was statistically significant difference between both groups regarding pH, PCO2, PO2 and O2 Sat. with the better values in patients of group A |