الفهرس 
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Abstract
Endotracheal intubation (ETI) and mechanical ventilation are often needed in patients with acute-on-chronic respiratory failure (ACRF) due to acute exacerbations of COPD. Prolonged duration of ETI is associated with an increased morbidity and mortality in intensive care unit patients. Weaning patients from mechanical ventilatory support remains a significant challenge despite of the several techniques that had been developed in the last few years to facilitate weaning. The aim of this study was to assess the usefulness of noninvasive ventilation (NIV) as an early extubation and weaning technique in ACRF. secondary to COPD. Among 72 patients consecutively intubated COPD patients admitted to PJCU of Assiut University for ACRF, a prospective randomized controlled trial of weaning was conducted in 37 patients who failed a 2 hour spontaneous breathing trial, although they met simple criteria for weaning. Conventional invasive pressure support ventilation (1PSV) was used as the control weaning technique in 18 patients (IPSV group) and .noninvasive ventilation (NIV) was applied immediately after extubation in 19 patients (NIV group). No statistical difference was found in the characteristics of the two groups at randomization. In the IPSV group, 12of 18 patoents were successfully weaned and extubated, versus 15 of 19 in the NIV group (p<0.05). NIV like IPSV significantly and similarly improved gas exchange in relation to that achieved during a 2-h spontaneous breathing trial (p<0.05). the duration of ETI was significantly shorter in the NIV group (4.79± 0.87) than in the IPSV group (8.03 ±1.39) (p<0.001). NIV reduced significantly the duration of ventilatory support, weaning failure, nosocomial pneumonia, ICU stay and hospital stay.