الفهرس 
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Abstract
The need for mechanical ventilation is a frequent reason for admission to an intensive care unit. The principal indications for mechanical ventilation are airway protection and respiratory failure. Respiratory failure is a clinical condition in which the respiratory system cannot maintain adequate blood pressure values of oxygen and carbon dioxide. The management of this clinical condition generates a dilemma between prompt endotracheal intubation (EI) or the implementation of non-invasive mechanical ventilation (NIV), which is an effective alternative because it reduces the need for EI and its related risks.
Improving the outcome of critically ill patients remains an idol that every practicing Intensivist strives to achieve. Every year there are many hundreds of research papers published that help us to better understand the physiology and pathophysiology of our patients and also how our treatment strategies interact and eventually alter a patient’s course.
The aim of this study was to provide baseline information for epidemiological trends, prognostic factors, and outcomes of patients on mechanical ventilation that will help planning of proper mechanical ventilation management programs.
This study was conducted on 130 mechanically ventilated (either invasive or noninvasive) adult patients admitted during the period from July 2013 to June 2014 to El-Mahalla Chest Hospital Intensive Care Unit.
Different demographic, clinical and laboratory variables were recorded at the time of admission and were compared between groups and between survivors and non-survivors patients upon discharge
This study revealed the following results:
The patients were divided into three groups A,B,C according to the mode of mechanical ventilation : -
Group A: Invasive mechanical ventilation : 52 patients (40%)
Group B: Noninvasive mechanical ventilation: 66 patients (50.77%)
Group C: Noninvasive mechanical ventilation failure that needed invasive mechanical ventilation: 12 patients (9.23%)
The mean age was relatively higher in groups (A&C) with male predominance and higher percentage of smokers in the three groups. The Glasgow coma scale, was significantly lowest in group A followed by group C and highest in group B. APACHE II score, was significantly highest in group A, followed by group C and lowest in group B. There was no significant difference between groups as regard age, sex, residence & history of smoking.
The highest associated co-morbidity was ischemic heart disease and the lowest was previous cerebrovascular accidents with no significant difference between the studied groups.
The most prevalent diagnosis in the three groups was COPD followed by interstitial lung disease, bronchial asthma and ARDS in group A, obesity hypoventilation and pulmonary odema in group B and obesity hypoventilation in group C. There is significant difference between groups.
The PH &Pao2 was significantly lowest in invasive and noninvasive failure group and highest in noninvasive mechanical ventilation. As regard Pco2 it was significantly highest in noninvasive failure group and lowest in noninvasive group. However, HCO3 level showed no significant difference between the studied groups.
The commonest cause of ICU admission in the three groups was impending respiratory failure followed by disturbed level of consciousness & shock with significant difference between the three groups.
The commonest indication of mechanical ventilation in all the studied patients was acute on top of chronic respiratory failure followed by acute hypoxemic respiratory failure , post arrest & coma
The commonly used initial mode of mechanical ventilation in invasive group was CMV followed by SIMV. In noninvasive group, it was BiPAP followed by CPAP. In noninvasive failure group, it was BiPAP, with significant difference between the three groups.
The highest percentage of invasive mechanical ventilation (Group A)was delivered by orotracheal tube and the highest percentage of noninvasive mechanical ventilation (Group B) was delivered by oronasal mask and all Noninvasive failure Group C was delivered by oronasal mask followed by orotracheal tube.
The commonest mode of weaning in invasive mechanically ventilated groups was pressure support . In noninvasive group B, mode of weaning was administration of o2 by nasal cannula or venturi with significant difference between the three groups .
The mean duration of mechanical ventilation , duration of weaning and the mean length of ICU admission was significantly highest in noninvasive failure group and lowest in Noninvasive group.
Invasive mechanical ventilation was associated with higher incidence of complication in the form of renal failure followed by ventilator acquired pneumonia, cardiogenic shock,Tracheostomy, pulmonary embolism & septicemia and acute liver cell failure Noninvasive mechanical ventilation associated with lower incidence of complication in the form of nasal bridge and ulceration . In noninvasive failure the highest associated complication was delayed intubation and brain anoxia. Development of complication was associated with high APACHE II score
There was low percentage of reintubation recorded in our study.
Invasive mechanical ventilation was associated with high mortality rate followed by noninvasive failure group with no recorded mortality in noninvasive ventilation.
As regard outcome, higher mortality rate was in female sex & was associated with positive history of smoking with no significant relation between outcome and sex, history of smoking.
High APACHE II score and low Glasgow coma scale were significantly associated with higher mortality rate.
Co-morbid diseases as atrial fibrillation, renal disease, and neuromuscular disease were significantly associated with higher mortality rate
As regard diagnosis, ARDS& pneumonia had higher mortality rate followed by bronchial asthma, interstitial lung disease, lower mortality was associated with COPD.
As regard cause of ICU admission, shock had higher mortality rate followed by impending respiratory failure.
As regard indication of mechanical ventilation, acute hypoxemic respiratory failure followed by post arrest had higher mortality rate than acute on top of chronic respiratory failure.
As regard mode of mechanical ventilation, noninvasive ventilation was associated with no mortality rate. IPPV was associated with higher mortality rate than SIMV. As regard mode of weaning, pressure support was associated with no mortality rate.
The cutoff point of APACHE II score is >30 had an optimal discrimination of patients with highest risk of ICU mortality.
The cutoff point of Glasgow Coma Score is <10 had an optimal discrimination of patients with highest risk of ICU mortality.