الفهرس 
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Abstract
This study aimed to assess the role of systemic interleukin-6 level and C-reactive protein as predictors of outcome of weaning from mechanical ventilation in acutely intoxicated patients and assess their role in selection of the most appropriate mode for weaning by comparing weaning by pressure support ventilation (PSV) mode, synchronized intermittent mandatory ventilation (SIMV) mode and weaning by the once-daily trial of spontaneous breathing method.
For this purpose we studied fifty eight acutely intoxicated patients, intubated and mechanically ventilated, admitted to the ICU of PCC of Ain Shams University during the period from May 2016 till September 2018. Patients were categorized consecutively according to the outcome of the 2-h SBT into 2 groups: group I (The SBT Success group): included 19 patients who succeed spontaneous breathing trial. group II (The SBT failed group): included 39 patients who failed spontaneous breathing trial which was further subdivided into 3 groups according to the method of weaning: group (1) PSV group, group (2) SIMV group and group (3) Once T-piece group,each group including 13 patients.
It was noticed that the highest incidence of poisoning was seen in patients in the middle age group in both success group and failed groups and males were more affected than females.
Organophosphate was the most prevalent cause of mechanical ventilation. Suicidal attempt was the cause of acute poisoning in majority of patients.
As regards serum interleukin-6, the study showed that it was elevated in both success and failed groups and it was higher in failed group on admission and during weaning trial, with no significant difference between both groups. This finding changed 2 days after where the serum interleukin-6 level was significantly difference between success and failed groups (p= 0.0149).
Regarding C-reactive protein, the study showed that there was no significant difference between both groups on admission, while it was significantly higher in the failed group compared to the success group during weaning trial and 2 days after ( p = 0.0050) (p = 0.0146) respectively.
In our study, we found that there was insignificant difference between 3 modes of difficult weaning from mechanical ventilation which are PSV, SIMV and the once-daily trial of spontaneous breathing method, although the highest success rate was in the PSV group while the highest failure rate was in the SIMV group and the time required for weaning with SIMV was longer than the other modes especially the T-piece trial.
The study also showed that there was no significant difference between the three weaning modes of difficult weaning regarding IL6 and CRP, during weaning trial and 2 days after when comparing PSV, SIMV, and Once T-piece groups.
While there was a significant difference between the three modes as regards PaO2, PaO2/FIO2 and PA-aO2 G measured 2 days after weaning trials. We had found that there was a significant difference when comparing PSV and SIMV groups and SIMV and Once T - piece groups, while it showed insignificant difference when comparing PSV and Once T- piece groups.
So PaO2, PaO2/FIO2 and PA-aO2 G could be used to compare weaning modes. The worst values were in SIMV group.
As regard vital signs, temperatures & RR was significantly higher in the failed group compared to the success group, pre weaning trial and during weaning trial.
Regarding Chemistry & Electrolytes there was significant decrease of both serum magnesium and calcium in failed group compared to the success group.
As regard CBC, hemoglobin concentration and Hct were significantly lower in the failed group compared to the success group, during weaning trial and 2 days after weaning trial.
Also, CPK-MB level was significantly higher in the failed group2 days after weaning trial.
As regard ABG & resp. function test, there was significant difference between success groups and failed groups, as regards PaO2, PaO2/FIO2 and PA-aO2 G, pre weaning trial and during weaning trial.
Regarding lung mechanics, there was a highly significant difference between patients who succeed and who failed weaning trials as regards RSBI index and significant difference regarding minute ventilation, pre weaning trial and during weaning trial.
The study also showed significant difference between the SBT success and SBT failure groups as regard X-ray findings.
The study showed that temperature, RR, RSBI, Minute ventilation, PaO2, PaO2/FIO2, PA-aO2 G and CRP could predict weaning outcome during weaning trial, while RSBI and RR had the highest sensitivity and specificity.