الفهرس 
Chronic Obstructive Pulmonary DiseaseOnly 14 pages are availabe for public view
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Abstract
C
OPD exacerbation represents a part of the common course of the disease, which is characterized by worsening of the patient’s baseline difficulty in breathing, cough, and/or sputum sufficient to intensify management which needs MV in acute respiratory failure patients with COPD exacerbation and associated with high rates of ICU mortality.
Weaning from invasive MV may be defined as the process of abrupt or gradual withdrawal of ventilator support, thereby shifting the work of breathing from machine to man. More than 40% of the time that a patient spends on MV is constituted by the weaning period, and around 20% of mechanically ventilated patients will fail their first attempt at weaning.
The reason for increased use of NIPPV is to avoid adverse effects of invasive ventilation in patients with COPD. Although invasive MV is very trustable, effective, and dependable in supporting alveolar ventilation, endotracheal intubation carries common dangerous problems. Further, prolonged MV, as often seen in COPD patients, is itself associated with complications like nosocomial pneumonia, cardiac morbidity, gastrointestinal bleeding, deep vein thrombosis and death. Thus, choosing the optimum time and right weaning method forms a crucial part of the management of such critically-ill patients and certainly affects their outcome.
This study was underwent on these patients who need invasive mechanical ventilation for more than 24 hours, a lot of challenges we face in our daily practice in ICU like difficult weaning, reintubation and VAP.
In this study we do our best to overcome these challenges by studying the effect of using of NIPPV both CPAP or BIPAP immediately after extubation or using T piece for 1 hour followed by extubation and using oxygen therapy and concluded that BIPAP improves patient gas exchange, hemodynamics and associated with shortest ICU stay which reflects on utilization of resources.