الفهرس 
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Abstract
Chronic Obstructive Pulmonary Disease (COPD) is
characterized by persistent air flow limitation that is usually
progressive, it is a major cause of chronic morbidity and mortality
throughout the world. Patients with acute exacerbation of COPD are
prone to developing respiratory failure.
Respiratory failure is defined as PaO2 below 60 mmHg with or
without PaCO2 above 49 mmHg in rest at sea level.
NIPPV is defined as the provision of ventilatory assistance to
the respiratory system without an invasive artificial airway.
BiPAP is a mode of NIV provides an inspiratory pressure (set as
IPAP ) in addition to expiratory positive pressure (set as EPAP) while
TriPAP is a mode of NIV uses three different pressure levels over the
course of the breathing cycle(IPAP, EPAP, and EEPAP).
Patients and methods:
This prospective study was carried out in, Chest Department,
Menoufia University Hospitals
Selection criteria
30 adult patients diagnosed as acute exacerbation of chronic
obstructive pulmonary disease (COPD) with type П respiratory
failure
1. Clinically, all patients had dyspnea, chronic cough or sputum
production, and/or a history of exposure to risk factors for the
disease especially smoking and confirmed by spirometry
2. In addition to the clinical signs of COPD, the following ABG
data had to be present to confirm type П respiratory failure (pH
< 7.35.,Serum HCO3≥ normal limits, PaCO2 > 45 mmHg and
PaO2 < 60 mmHg.)
Exclusion criteria
- Respiratory failure due to other causes
- Uncontrolled cardiac arrhythmias and unstable angina.
- other pulmonary disorders
- PH < 7.20 - GCS< 8 -Confusion or Agitation
all patients were randomized into two groups. First group was
treated with standard therapy(including antibiotics, bronchodilator,
corticosteroids, expectorants, oxygen, physiotherapy and prophylactic
heparin) plus BiPAP. Second group was treated with standard therapy
plus Tripap
All patients underwent the following:
1. History taking
2. Clinical examination looking for signs of COPD and RF
3. Arterial blood gases analysis before, during and after NIPPV(initial
reading and after 6h, 12h, 24h, 24h, 48h, 72h)
4. Plain chest radiography
5. Routine laboratory investigation
Results :
6. Males to females ratio in both groups was 2:1,There were 10
males and 5 females in each group.
7. In BiPAP group, the mean age was(56±11.1) years, while in
TriPAP group the mean age was(57.2±10.9) years. There was
no statistically significant difference between both groups.
8. The mean BMI in BiPAP group was 26.9±4.7 kg/m2, while it
was 26.4± 4.4 kg/m2 in TriPAP group.There was no statistically
significant difference between both groups regarding BMI.
9. Duration of ICU stay was (8.7 ± 2.3) days in BiPAP group
while it was (9.06 ± 2.2) days in TriPAP group with no
significant difference.
10. Patients showed significant difference between initial and final
pH (7.26±0.03 and 7.34±0.084 respectively) for BiPAP group
and (7.23±0.03 and 7.36±0.06 respectively) for TriPAP
group. but there was no significant difference between both
groups in pH.
11. Patients showed significant difference between initial and final
PaCO2 (77.3±8.5and 47.7±2.4 mmHg respectively) for BiPAP
group and (72.4±7.7and 50.7±1.9 mmHg respectively) for
TriPAP group, but there was no significant difference between
both groups.
12. Patients showed significant difference between initial and final
PaO2 (58.8±5.6 and 64.4±5.9 mmHg respectively) for BiPAP
group and (49.4±6.1and 62.6±7.1mmHg respectively) for
TriPAP group. but there was no significant difference between
both groups.
13. Patients showed significant difference between initial Sat O2
and final PaO2 (83.6±5.9, 88.0±4.3 % respectively) for BiPAP
group and (79.1±8.0, 89.2±5.9 % respectively) for TriPAP
group. but there was no significant difference between both
groups.
14. There was no significant difference between both groups
regarding outcome of weaning as 80% of patients were
improved and discharged(12 patients in each group) and only
20% of patients were connected to MV.
15. The present study revealed no significant difference between
males and females regarding outcome of NIPPV
16. The present study revealed that there was no significant
difference between discharged patients and patients connected
to MV regarding age in both groups(54.7±10.3and 64.1±10.2
years respectively)
17. Our study revealed that significant difference was shown
between discharged patients and patients connected to MV
regarding BMI(24.8+2.1and 34.3+1.3kg/m2 respectively)