الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Non-invasive ventilation (non-invasive ventilation) is a procedure of providing the patient with positive pressure ventilation without the use of endotracheal tube. Non-invasive ventilation has two main types: continuous positive airway pressure (CPAP) and bi-level positive airway pressure (BIPAP). Non-invasive mechanical ventilation (non-invasive ventilation) as (CPAP) and (BIPAP) has become widely practiced in (ICUs), primarily because its use can obviate the need for intubation in patients with acute respiratory failure secondary to chronic obstructive pulmonary disease (COPD) or acute cardiogenic pulmonary edema. Compared with invasive mechanical ventilation, this type of ventilation achieves the same physiological benefits of reduced work of breathing and improved gas exchange. Furthermore, it avoids the complications of intubation and the increased risks of ventilator-associated pneumonia and sinusitis, especially in patients who are immunosuppressed or with comorbidities. Since artificial airways are not required for the using of non-invasive ventilation, a fewer complication is associated with non-invasive ventilation comparing to invasive ventilation, even though there are some disadvantages of using non-invasive ventilation such as nasal bridge ulceration and discomfort due to the mask Some studies reported that non-invasive ventilation was challenging to apply in the intensive care unit (ICU) because of patient agitation, those studies reported that, patients who used dexmedetomidine had much better outcome in term of discharge from ICU compared to those who didn’t use sedation. Non-invasive ventilation is useful for many cases, but only a few patients could tolerate this procedure due to the discomfort of using this type of ventilation. Therefore, some studies found that using sedation during non-invasive ventilation technique should be considered to reduce the percentage of non-invasive ventilation failure and comfort the patient during non-invasive ventilation. A desirable sedation should facilitate mechanical ventilation and sleep, allay anxiety, release pain, and alleviate physiologic responses to stress including tachycardia, shortness of breath and hypertension without depressing respiration or hypoxic drive and cough reflex. As a result, the patients who were given dexmedetomidine had shown a remarkably decreased failure percentage of non-invasive ventilation, which reduced the need for intubation and eased the weaning from mechanical ventilation. Due to the daily use of non-invasive ventilation in ICU, the outcome of this research will help in guiding health care providers, this research aimed to investigate the association of using sedation during non-invasive ventilation with intubation rate and ICU length of stay. The aim of our study is to improve the outcomes of non-invasive ventilation through reduction of its intolerance and failure rate in the form of intubation and hence reduction of complications of intubation and ventilation and hence reduce ICU stay and better health outcomes. This prospective randomized clinical trial was conducted on 90 patients in the ICU of Tanta university Hospitals. We included non-invasive ventilation patients who had Pulse oxygen saturation (SpO2) was less than 90% while inspiration of oxygen was more than 10 L/min through reservoir mask, acute respiratory acidosis showed levels of partial pressure of carbon dioxide in artery (PaCO2) were more than 45 mmHg, respiratory distress, including both more than 24 breaths per minute of respiratory rate (RR) and enhanced use of accessory respiratory muscle. One of the major causes of non-invasive ventilation failure is patient agitation and anxiety, we tried to overcome this problem using dexmedetomidine and propofol on 30 patients in each drug group and a control group of 30 patents was added, they didn’t receive any sedation or analgesia. Summary of our results • There was an insignificant difference among three groups in baseline characters (Age, sex, and BMI). • Baseline vital signs and ABG were insignificantly different among the three groups. By comparing the rate of intubation, sedative effect of each drug using SAS, pain using VAS, hemodynamics, blood gases, with each drug group to determine which drug is more efficient and we found the following: • Among the three groups, there was no significant difference in SAS score and VAS at baseline, but difference between both D group and P group was significant at 1 hour, 6-hour, 12 hour and 24 hours during continuous intravenous infusion of Dexmedetomidine or propofol at its’ lower limit. • group D showed better hemodynamics and Respiratory parameters than group P with significant Difference between both groups at its lower limit, with worse hemodynamics Parameters In group C with significant difference between it and group D & P. • Blood Pressure and heart rate improved during continuous intravenous infusion of Dexmedetomidine and propofol in group D and P compared with baseline, and not improved in group C , the difference between-group comparisons was significant between D and P at its’ lower limit at 1 hour after sedation , 6 hour, 12 hour and 24 hour between the two groups with significant increase in MAP in the control group at 1 hour after sedation , 6 hour, 12 hour and 24 hour. • RR reduced and pH level raised gradually to its’ normal values during continuous intravenous infusion of Dexmedetomidine and propofol in group D and group P with no significant difference between both groups, but RR and PH showed little slow improvement in control group. • Arterial blood gases comparison between the three Groups showed improvement in both group D and P with Little improvement in group C With insignificant difference between both groups D and P and significant difference between both groups and group C. • SpO2 improved significantly in the two groups D and P with slight improvement in group C. • Continuous intravenous infusion of Dexmedetomidine resulted in better sedative effect than propofol after non-invasive ventilation initiation, which is reflected in less cases who needed midazolam injections in group D (7 cases) than group P (16 cases) • In comparison with propofol, both sedation and analgesia were induced by Dexmedetomidine Which reflected in less cases needed fentanyl injections in group D (7 cases) than group P (14 cases) • Continuous intravenous infusion of Dexmedetomidine led to a stabler state of hemodynamics and more improvement in Respiratory rate with significant difference -at its’ lower limit- with Propofol group, and improvement in Blood gases between the two groups was significant between both groups with control and insignificant when compared both groups D and P with each other’s. • The comparison between the three groups showed no significant difference between group D and P but the difference was significant with group C which means that both groups D and P showed better results and shortened ICU Stay than control group. • The comparison between the three groups showed no significant difference between them in the time to intubation which means that both drugs have no significant effects on this parameter.