Background: A consensus about the best weaning procedure, haven't been reached. Patient–ventilator dyssynchrony can lead to considerable patient distress, prolongs mechanical ventilation and (ICU) length of stay. PAV+ delivers positive pressure ventilation in proportion to instantaneous inspiratory effort, reduces ventilator dyssynchrony and the duration of weaning from the ventilator. Aim: Evaluate weaning outcome for COPD patients using PAV+ versus PSV, assess patient ventilator asynchrony during weaning, compare ICU outcome (hospital length of stay, ICU and hospital mortality). Patients & Methods: 150 mechanically ventilated COPD patients were enrolled in this prospective, parallel randomized clinical trial and assigned to either PAV+ or PSV spontaneous breathing trial for weaning (after meeting specific eligibility criteria). Asynchrony was detected with bedside waveform interpretation of flow and airway pressure for 30 minutes. Results: Weaning success was recorded in 73.3% PAV+ vs. 66.7% PSV (P= 0.373). Asynchrony events was significantly less in PAV+ vs. PSV; ineffective triggering (14.9 ± 10.3 vs. 37.6 ± 26.6, p = 0.001), double triggering (3.01 ± 3.2 vs. 8.0 ± 5.8, p = 0.001) and delayed cycling (11.81 ± 6.95 vs. 15.20 ± 8.97, p = 0.006). Asynchrony index was significantly lower for PAV+ (7.05 ± 3.08 vs. 9.38 ± 4.07, p = 0.001) as well as duration of hospital stay (10.7 ± 4.0 vs. 13.1 ± 7.1, p = 0.047). Conclusion: PAV+ proved to be as successful as PSV in weaning of COPD patients. Significant reduction in patient ventilator dyssynchrony and hospital stay was noted with PAV+.

Background: Mechanical ventilation (MV) can cause progressive thinning of diaphragm muscle and hence progressive decline in diaphragmatic function. We aimed to assess the rate at which diaphragm thickness (tdi) changed during MV and its effect on weaning outcome using transthoracic ultrasound (TUS) evaluation in COPD patients. Methods: Thirty mechanically ventilated COPD patients were enrolled in this cohort study. Baseline Tdi were recorded within 24 hrs of MV after stoppage of sedation using TUS. The subsequent measurements were recorded at the 3rd day, 5th day and 7th day of MV and at time of initiation of weaning. Results: There was a significant drop in tdi at end expiration and at end inspiration by about 27.2% and 17%, 35.5% and 18.5% at 3rd and 5th day of MV respectively compared to baseline parameters. In the 10 patients who were still on ventilator till the 7th day, tdi were significantly lower compared to baseline recordings. Percentage of decline of tdi at end inspiration from baseline recordings was significantly higher in patients with difficult weaning than in those with simple weaning. The optimum cut off value of % of decline of tdi at end inspiration associated with difficult weaning was ≥ 10.6% giving 88.9% sensitivity and 83.3% specificity. Conclusion: MV is associated with gradual diaphragmatic atrophy which can be detected by TUS and could predict weaning outcome in mechanically ventilated COPD patients.

Background: Mechanical ventilation (MV) can cause progressive thinning of diaphragm muscle and hence progressive decline in diaphragmatic function. We aimed to assess the rate at which diaphragm thickness (tdi) changed during MV and its effect on weaning outcome using transthoracic ultrasound (TUS) evaluation in COPD patients. Methods: Thirty mechanically ventilated COPD patients were enrolled in this cohort study. Baseline Tdi were recorded within 24 hrs of MV after stoppage of sedation using TUS. The subsequent measurements were recorded at the 3rd day, 5th day and 7th day of MV and at time of initiation of weaning. Results: There was a significant drop in tdi at end expiration and at end inspiration by about 27.2% and 17%, 35.5% and 18.5% at 3rd and 5th day of MV respectively compared to baseline parameters. In the 10 patients who were still on ventilator till the 7th day, tdi were significantly lower compared to baseline recordings. Percentage of decline of tdi at end inspiration from baseline recordings was significantly higher in patients with difficult weaning than in those with simple weaning. The optimum cut off value of % of decline of tdi at end inspiration associated with difficult weaning was ≥ 10.6% giving 88.9% sensitivity and 83.3% specificity. Conclusion: MV is associated with gradual diaphragmatic atrophy which can be detected by TUS and could predict weaning outcome in mechanically ventilated COPD patients.

Background: Mechanical ventilation (MV) can cause progressive thinning of diaphragm muscle and hence progressive decline in diaphragmatic function. We aimed to assess the rate at which diaphragm thickness (tdi) changed during MV and its effect on weaning outcome using transthoracic ultrasound (TUS) evaluation in COPD patients. Methods: Thirty mechanically ventilated COPD patients were enrolled in this cohort study. Baseline Tdi were recorded within 24 hrs of MV after stoppage of sedation using TUS. The subsequent measurements were recorded at the 3rd day, 5th day and 7th day of MV and at time of initiation of weaning. Results: There was a significant drop in tdi at end expiration and at end inspiration by about 27.2% and 17%, 35.5% and 18.5% at 3rd and 5th day of MV respectively compared to baseline parameters. In the 10 patients who were still on ventilator till the 7th day, tdi were significantly lower compared to baseline recordings. Percentage of decline of tdi at end inspiration from baseline recordings was significantly higher in patients with difficult weaning than in those with simple weaning. The optimum cut off value of % of decline of tdi at end inspiration associated with difficult weaning was ≥ 10.6% giving 88.9% sensitivity and 83.3% specificity. Conclusion: MV is associated with gradual diaphragmatic atrophy which can be detected by TUS and could predict weaning outcome in mechanically ventilated COPD patients.

Background Pressure support ventilation (PSV) mode and T-piece trial were used as weaning methods in mechanically ventilated COPD (chronic obstructive pulmonary disease) patients. Thus, the objective of study to assess the value of combining T-piece trial to PSV mode in weaning of COPD patients. Patients and methods 80 mechanically ventilated COPD patients admitted to respiratory intensive care were divided into two groups, group I: 40 patients weaned by PSV mode and group II: 40 patients weaned by PSV mode and T-piece trial. Results The mean age of patients were 62 years. (73.8%) were males and (73.75%) were smokers. No significant differences were found between both groups in age, sex, body mass index, smoking status, APACHE score, exacerbation frequency and hospital admission. No significant differences were found between both groups as regard vital capacity, negative inspiratory force, rapid shallow breathing index, PaO2 (partial arterial oxygen pressure), PaCO2 (partial arterial carbon dioxide pressure) and arterial oxygen saturation at the end of PSV mode in both groups. A significant decrease in PaO2, arterial oxygen saturation and increase in PaCO2 were observed in group II patients after adding T-piece trial. 34(85%) patients were successfully extubated in group I, while 33 (82.5%) patients were successfully extubated in group II. Duration of MV, duration of weaning, ICU stay and mortality were significantly higher in group II patients.

Background Pressure support ventilation (PSV) mode and T-piece trial were used as weaning methods in mechanically ventilated COPD (chronic obstructive pulmonary disease) patients. Thus, the objective of study to assess the value of combining T-piece trial to PSV mode in weaning of COPD patients. Patients and methods 80 mechanically ventilated COPD patients admitted to respiratory intensive care were divided into two groups, group I: 40 patients weaned by PSV mode and group II: 40 patients weaned by PSV mode and T-piece trial. Results The mean age of patients were 62 years. (73.8%) were males and (73.75%) were smokers. No significant differences were found between both groups in age, sex, body mass index, smoking status, APACHE score, exacerbation frequency and hospital admission. No significant differences were found between both groups as regard vital capacity, negative inspiratory force, rapid shallow breathing index, PaO2 (partial arterial oxygen pressure), PaCO2 (partial arterial carbon dioxide pressure) and arterial oxygen saturation at the end of PSV mode in both groups. A significant decrease in PaO2, arterial oxygen saturation and increase in PaCO2 were observed in group II patients after adding T-piece trial. 34(85%) patients were successfully extubated in group I, while 33 (82.5%) patients were successfully extubated in group II. Duration of MV, duration of weaning, ICU stay and mortality were significantly higher in group II patients.

Background Pressure support ventilation (PSV) mode and T-piece trial were used as weaning methods in mechanically ventilated COPD (chronic obstructive pulmonary disease) patients. Thus, the objective of study to assess the value of combining T-piece trial to PSV mode in weaning of COPD patients. Patients and methods 80 mechanically ventilated COPD patients admitted to respiratory intensive care were divided into two groups, group I: 40 patients weaned by PSV mode and group II: 40 patients weaned by PSV mode and T-piece trial. Results The mean age of patients were 62 years. (73.8%) were males and (73.75%) were smokers. No significant differences were found between both groups in age, sex, body mass index, smoking status, APACHE score, exacerbation frequency and hospital admission. No significant differences were found between both groups as regard vital capacity, negative inspiratory force, rapid shallow breathing index, PaO2 (partial arterial oxygen pressure), PaCO2 (partial arterial carbon dioxide pressure) and arterial oxygen saturation at the end of PSV mode in both groups. A significant decrease in PaO2, arterial oxygen saturation and increase in PaCO2 were observed in group II patients after adding T-piece trial. 34(85%) patients were successfully extubated in group I, while 33 (82.5%) patients were successfully extubated in group II. Duration of MV, duration of weaning, ICU stay and mortality were significantly higher in group II patients.

Aspergilli are the main causal agent of invasive apergillosis chest disease. A total of 80 isolates of Aspergillus flavus (20), A. fumigatus (15), A. niger (30) and A. terreus (15) isolates, previously recovered from aspergillosis suspected patients at Assiut university hospitals, were assayed for their enzymes and toxins profile. The results revealed that, all of the tested isolates had the ability to utilize calf lung tissue in addition, to produce catalase, peroxidase. Meanwhile, 82.5-90% isolates produced protease, lipase, urease, phospholipase whereas, 70% of isolates exhibited hemolytic activities. TLC of the cleaned extracts of the tested isolates exhibited the ability of all A. flavus isolates assayed to produce aflatoxins B1 & G1, 53%, moreover, A. fumigatus isolates produced fumagillin and gliotoxin. On the other side, 43.3 % & 23.3% of A. niger isolates produced ochratoxins & gliotoxin respectively. Virulence assay of 10 μl of gliotoxin standard and cleaned extracts of A. fumigatus toxic isolates showed necrotic area on Guinea Pigs lungs compared to the control. Thus, opportunistic fungi isolated from aspergillosis patients possess high enzymatic and toxic profile that might play an important role in their mycopathy.

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