الفهرس 
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Abstract
Summary
Poor prognosis, abrupt worsening of respiratory symptoms, and impaired respiratory function are all signs of an acute exacerbation of COPD. Acute respiratory failure is a common complication of COPD exacerbations that range from moderate to severe, necessitating hospitalization and emergency department.Patients with acute progressive COPD exacerbations and respiratory failure are recommended to use NIV as an additional method of treatment. It is advised to utilize NIV in the treatment of COPD patients with type II respiratory failure since it has been demonstrated to lower the intubation rate and increase the survival rate of patients requiring ventilation support. However, NIV has disadvantages, such as reduced comfort and poor interaction and synchronization between patients and ventilators, which are often difficult to identify and manage. In recent years, HFNC has been increasingly applied in stabilizing and aggravating COPD patients.
This clinical randomized study was conducted on 40 patients admitted by COPD exacerbation complicated by type II respiratory failure, in the critical care department at Beni –suef university , starting from February 2022 to January 2023. Patients were randomly divided into two groups :-
group (A) consists of 20 patients on non invasive positive pressure ventilation (NIPPV).
group (B) consists of 20 patients on high velocity nasal cannula (HVNC).
As regard demographic data, there was no stastically significant difference between age in both groups and the same regarding sex also .
Conerning comorbidities and risk factors, our study detected that there was a number of comorbidities and risk factors related to the patients involved in both groups, in group A, 6 patients (30%) were hypertensive in group (A) while in group B there were 5 pts(25%) , in group A there was 1 diabetic patient (5%) while in group B, 4 pts (20%), in group A, 9 patients ( 45%) were smokers while in group B, 4 pts (20%) , in group A , 2 pts (10%) had ischemic heart disease and the same percent was in group B. comorbidities and risk factors showing no significant difference between the studied groups.
As regard NIPPV parameters, Initially on admission the parameters of noninvasive ventilation were of mean value ± SD (PEEP 5.2±1mmHg , PS 13.3±3mmHg, Fio2 47.7±12.9% , TV 426.7±54.2ml, while at the end of intervention after 2 hours it was (PEEP 5.2±1.2mmHg , PS 12.4±3.3mmHg , Fio247.9±10.9% , TV 415.5±52ml ). there was no statistically significant difference between the 1 st and 2nd settings regarding PEEP, PS, FIO 2 , and TV (P-value>0.05). Regarding HVNC parameters, Intially the parameters of HVNC were of mean value ± SD (Flow 30.2±8.4L/sec , Fio 2 40.3±13.2% , So2 80.8±7.9%) then at the end of intervention the mean value ± SD were (Flow 29.7±7.1L/sec, So2 93.9±1.5%). there was no statistically significant difference between the 1st and 2nd settings regarding flow and Fio 2 (P-value>0.05). The SO2 increased significantly from 1st (80.8±7.9%) to 2nd hour (93.9±1.5%).
Concerning Arterial blood gases,on admission, there was a statistically lower PH of positive pressure NIPPV group than HVNC group on admission , but after two hours the PH showed no significant difference between the two groups as there was a significant increase of PH in both.
Regarding the PCO2, both groups didn’t differ significantly on admission with significant decrease in both groups, but the improvement was more in the HVNC group. The HCO3 didn’t differ between the two groups on admission & after two hours with no significant difference between the 2 hours in each group.
Concerning need of intubation, there was no significant difference between the two groups regarding their need of intubation (P-value>0.05).
With reference to mortality, there was no significant difference between the two groups regarding the incidence proportion of mortality (P-value>0.05). As regard length of ICU stay, showed that there was no significant difference between the studied groups regarding the length of ICU stay (P-value>0.05).
Comparison between the studied groups regarding the causes of disease failure, there was no significant difference between the studied groups regarding the inc. hypercapnia (P-value>0.05) but, the intolerance and the respiratory distress was significantly lower in the HVNC group (P-value<0.001).