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Abstract
COPD is the fourth leading cause of death worldwide . The development of acute respiratory failure (ARF) in COPD patients is a serious life threatening complication. Endotracheal intubation and mechanical ventilation are often needed in these patients, who may undergo difficulties in the weaning process. Weaning patients from mechanical ventilatory support remains a significant challenge, especially in COPD patients.
Weaning techniques differ considerably from one another. A better knowledge of the best weaning modality could help improve the general management of patients and , ultimately, lead to a greater rate of discontinuation of MV and reduced human and financial costs.
The aim of the present study was to compare the efficacy of five modes of weaning patients with COPD from MV; once daily T piece trial, PSV, SIMV, CPAP and NPPV ( non-invasive BiPAP).
The study included ninety COPD patients [ 60 males ( 66.7%) and 30 females (33.3%) with a mean age of 61.01% years ± 11.85 SD, complicated y type 2 acute on top of chronic respiratory failure. All of them were mechanically ventilated in the volume A/C mode. Medical therapy was optimized and ABG analysis was done at regular intervals.
We followed a multidisciplinary weaning protocol incorporating daily screening of respiratory function with a trial of spontaneous breathing.
Patients who passed the daily screening program, underwent a trial of spontaneous breathing (SBT) lasting up to two hours. The results of the SBT revealed that; 40 patients ( 44.5%) of the 90 patients enrolled in the study succeeded the initial SBT and extubated without and method of gradual weaning. The remaining 50 patients (55.5%) failed the 2h-SBT. They were randomly classified into five groups to be weaned by one of the five studied modes of gradual withdrawal of ventilatory support.
According to the results of the initial SBT, we classified our patient population into two groups; the first group(GI) included the patients who succeeded the SPT, while the second group (GII) includes those who failed that trial ( ” difficult to wean” patient).
Regarding the admission criteria: there was no significant difference between the succeeded (GI) and the failed (GII) groups concerning the.