الفهرس 
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Abstract
No significant difference was found between both studied groups as regard all baseline diaphragmatic function namely (respiratory thickness and excursion) (P>0.05). Meanwhile after weaning, group 1 have statistically higher mean (mm) for all diaphragmatic function than group 2 (P=0.046, 0.011 and 0.038) respectively Outcome analyses showed that the early rehabilitation group either invasive or non-invasive MV had a shorter duration of MV and ICU stay (days), higher rate of simple successful weaning, less incidence of nosocomial pneumonia and significantly lower PCO2 (mmHg) as compared to group 2 (63.07±5.05 versus 65.97±4.89 (mmHg); P= 0.023) respectively. And also among invasive MV patients, group 1 had significantly higher NIF (-21.39±3.96 versus -19.00± 4.78; P=0.006) and significantly lower airway occlusion pressure (4.79±1.47 versus 6.65±2.79; P= 0.007) as compared to group 2 . Regarding patients with invasive ventilator support, patients with simple weaning have significantly higher mean electrical stimulation of quadriceps muscle and higher mean duration as compared to difficult weaning patients (13.10±4.21 versus 9.00±4.09, P=0.011 and 22.57±6.42 versus 18.08±4.89, P=0.040). In contrast, trigger sensitivity (%) show no significant difference with the type of weaning (P>0.05). Regarding patients with non-invasive ventilator support, no significantly difference was observed between the type of weaning and the mean electrical stimulation of quadriceps muscle (P=0.203), and also no significant difference was found between the outcome of weaning (success or failed) and rehabilitation components either among patients with invasive or non-invasive ventilator support (P>0.05) . The predictive ability of Electrical stimulation (ms), Trigger sensitivity (%) and diaphragmatic functions (at inspiration, at expiration and at excursion) in COPD patients for prediction of simple weaning using the ROC curves show that the areas under the ROC curves for them were 75.6%, 58.7%, 72.2%, 70.6% and 68.0%, respectively. Electrical stimulation (ms) and at weaning IT were observed to be significantly better predictors of simple weaning with higher AUC (p=0.016 and 0.000) respectively. Univariate logistic regression analysis showed that the DT at inspiration, at excursion, APATCH, SOFA score and simple weaning as statistically significant variables for successful weaning prediction. In the Multivariate analysis we only included the highly significant predictors namely (DT at inspiration, excursion and simple weaning) due to small sample size. Multivariate analysis confirmed simple weaning to be associated with successful weaning (OR=0.134.2, 95%CI: 10.07–1787.7, P=0.000). Other variables have no role in detection of weaning outcome (P>0.05). Also group 1 has have significantly lower hospital and ICU re admission as compared to group 2 patients (P=0.000 and 0.001) respectively. Regarding the thirty day mortality as a measure of outcome among both studied groups, for invasive ventillatory supported patients group1 has significantly better outcome in comparison to group 2, 29 (88%) of group 1 versus 27 (68%) patients of group 2 were survived and discharged from the hospital while 4 (12%) and 13 (32%) patients of the group 1 and group 2 respectively were died (P=0.040). Also the same was found among patients who received non-invasive ventilator support group1 has significantly better outcome in comparison to group 2, 18 (90%) of group 1 versus 8 (53%) patients of group 2 were survived and discharged from the hospital while 2 (10%) and 7 (47%) patients of the group 1 and group 2 respectively were died (P=0.022) In summary, we found that early rehabilitation was beneficial for COPD patients with ARF and in a medical ICU.. We can conclude that; Early PR is an effective intervention and superior to usual care in reducing duration on mechanical venitalation ,length of ICU stay ,length of hospital stay , nosocomial pneumonia mortality ,facilat weaning from mechains and improve health-related quality of life (HRQOL) Recommendations
Based on the current findings, the present study recommends: PR should be initiated as early as possible in critically ill mechanical ventilated copd patient and should be continue after discharge from ICU. Further studies are needed to use different methods for inspitory muscle training other than trigger sensitivity, to identify the optimal EMS dosage for ICUAW prevention (both in terms of frequency, intensity and volume), and to describe the feasibility, safety, and cost-effectiveness of EMS in different subpopulations of critically ill patients.