الفهرس 
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Abstract
This study was conducted at Pediatric Intensive Care Unit (PICU), Children’s Hospital, Ain Shams University during the period from June 2009 to June 2011.
It included 30 pediatric patients admitted due to acute respiratory failure secondary to bronchopneumonia during the period of the study.
The aim of the study was to compare the use of non invasive ventilation technique to the use of invasive ventilation technique using the classic endotracheal tube applied to patients with acute respiratory failure.
Patients were divided into two groups:
The first group was put on invasive mechanical ventilation with a mean age and SD of 1.5+0.6 with a male to female ratio of 8:7.
The second group was put on non invasive mechanical ventilation with mean age 2.6+1.2 SD with a male to female ratio of 2:1
The demographic distribution of the two groups was not statistically different, with a mean age and SD of 1.5+0.6 with a male to female ratio of 8:7 in the invasive group compared to a mean age 2.6+1.2 SD with a male to female ratio of 2:1 in the non invasive group. The current study has found that there was no significant difference between the two groups as regards initial PRISM score with a mean PRISM of 15.7±3 and predicted mortality of 19±18% in the non invasive group compared to a mean PRISM of 11.4±4 and predicted mortality of 14.±20% in the invasive group.
The initial complete blood picture done for both groups was not statistically different with a mean hemoglobin level of 9.5±2 g/dl for the non invasive group compared to 10.6±1.9 g/dl in the invasive group, while the mean platelets count was 329±165 /mm3 in the non invasive compared to 303±143 /mm3 in the invasive group.
The mean total leucocytic count among the non invasive group was 15.1±5.8 /mm3 with an absolute neutrophilic count of 6.5±2 /mm3 compared to a mean total leucocytic count of 11.2±6.6/mm3 with an absolute neutrophilic count of 10.8±2 / mm3 in the invasive group
The mean initial C reactive protein in the non invasive group was 22.8±14 mg/L compared to a mean of 9.2±7 mg/L in the invasive group.
The initial arterial blood gases were not statistically different with a mean PH of 7.1±0.2 and a mean PO2 of 55±7 mm/hg and a mean HCO3 of mEq/L among the non invasive group here in the non invasive group the mean PH was7.2±0.4, mean PO2 OF 56±9 mm/hg, and a mean HCO3 OF 21.6±6 mEq/L. But on the other hand the mean PCO2 in the non invasive group was 47.5±10 mmHg compared to a mean PCO2 of 62.6±21 mmHg in the invasive group with a statistically significant difference.
After three days of mechanical ventilation, the current study found that there was a higher CRP and PMNL among invasive group with an increase in the mean CRP from 9.2±3 mg/l to 24.9±5mg/l with a change of 107% and an increment in the mean PMNL from 10.9±2 to 14±2 /mm3 in the non invasive group with a change of 30 giving a significant statistical difference.
The current study found that there was a significant decrease in the CRP and PMNL in the non invasive group with a decrease in the mean CRP from 22.8±1 to 0 mg/l with a change of 100% and a decline in the mean of PMNL from 6.5±2 to 4.3±0.9/mm3 with a change of 30% in the non invasive group.
The incidence of ventilation associated pneumonia (VAP) among the invasive group was 9 out of 15 cases (60%) in 198 ventilation days, compared to 0 out of 15 cases in 198 ventilation days (0%) among non invasive group with high statistical significance.
The current study found that there was no significant difference between the two groups as regards results of blood cultures with a positive growth of MRSA in one patient out of 15 (6.7%) on admission in the non invasive group and no growth after follow up on the third day of ventilation, where on the other hand there was one positive culture out of 15 (6.7%) on admission among the invasive group and on follow up 5 cases out of 15 33.3% had positive growth with 1 case MRSA(6.7%),2 cases staph negative coagulase 13.3% and 2 cases Klebsiella 13.3%.
The bronchoalveolar lavage performed in the current study found that: on admission there was no significant statistical difference between both groups with a 8 cases out of 15(53.3%) with a positive growth [3 cases (20%) with staph negative coagulase and 5 cases with klebsiella (33.3%)] compared to 4 cases out of 15 (26.7%) in the invasive group [2 cases staph (13.3%), 1 case klebsiella (6.7%), 1 case candida (6.7%)].
Results obtained on the third day of ventilation found that there was significant difference between both groups, as there was more growth of bacteria in the invasive group 9 cases out of 15 (60%) with a growth of (3 cases MRSA (20%), 5 cases staph (33.3%), 1 case klebsiella (6.7%) compared to 0 out of 15cases (0%) among the non invasive group.
The most prevalent organisms were staph negative coagulase 53.3 % followed by klebsiella 6% The current study found that invasive group required more frequent combined antibiotic use with statistically significant difference between both.
On comparing the two groups there was no significant difference as regards the use of sedation.
The frequency and type of complications came as follow: there was higher frequency of pneumothorax, (6 cases out of 15 (40%) in the invasive group and 0 out of 15 (0%) among non invasive group with highly significant difference.
Non invasive group had higher frequency of nasal ulcers with 11 cases out of 15 (74.3%) and 0 cases out of 15 (0%) among the invasive group.
1 case out 15 (6.7%), in the invasive group, suffered from subglottic stenosis.
The incidence of gastric distension among the non invasive group was 15 cases out of 15(100%) if compared to incidence of 8 out of 15 cases (53.3%) in the invasive group with a significant statistical difference.
There was statistically significant difference between both groups as regards mortality with 0% (0 case out of 15) mortality rate in the non invasive group and a mortality rate of 33.3% (5 cases out of 15) for the invasive group.
The total ventilation days for both groups were 198 ventilation days. The non invasive group had a mean and SD of 5.2+2 ventilation days compared to 8.9+3 ventilation days in invasive group with a significant statistical difference.
The length of stay in PICU among the non invasive group was mean and SD 6.2+3 days compared to 12+4.9 days in the invasive group.
The current study found that the cost of stay was significantly lower in the non invasive group with a mean and SD 4566+2313 LE and range 2000-8000 LE for the non invasive group if compared to the invasive group with a mean of 10000+4928 LE and range of 3000-20000LE.