الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
COPD is a common disease with multiple complications and substantial mortality. The use of invasive MV sometimes is inevitable lifesaving step in management of advanced cases of COPD. The invasive MV should be discontinued at the earliest possible time in the course of a patient’s illness. Discontinuation of mechanical ventilation is a two-step process. First, patients who may be ready to wean are identified using various predictors of weaning outcome. Weaning is then initiated in those patients. Weaning COPD patients from mechanical ventilation remains a significant challenge.
Extubation is performed after the decision has been made to disconnect the patient from MV and after the patient has tolerated a spontaneous breathing trial (SBT).However, extubation failure (EF) occurs in approximately 14% to 32% of the patients meeting these criteria.
CgA is an acidic protein with a molecular weight of 48 kDa that is composed of 439 amino acids and expressed by several normal or neoplastic cells of the diffuse endocrine and neuroendocrine systems or by some cancer cells that can undergo neuroendocrine differentiation. Its name is derived from the original discovery in adrenal medulla. . It is widely recognized that the adrenal medulla is the main source of circulating CgA, while adrenergic nerve endings and neuroendocrine cells secrete CgA in peripheral tissues. Present in the diffuse neuroendocrine system, it has also been detected in rat and human cardiac secretory granules where it is co-stored with natriuretic peptide hormones and released mainly under stress conditions.
The aim of this study was to investigate the utility of the CgA as a markerof weaning in mechanically ventilated chronic Obstructive Pulmonary Disease patients.
This study was conducted on 50 patients admitted to the Critical Care Medicine Department in Alexandria Main University Hospital. The 50 patients were adult mechanically ventilated COPD patients admitted and were considered eligible for weaning (fulfilling the inclusion criteria) after at least 48 hours of invasive mechanical ventilation. For Enrolled Patients, echocardiography to assess left ventricular systolic function was done at the date of admission. Vital signs (heart rate and arterial blood pressure), demographic data, ICU admission diagnosis, comorbidities, days in ICU, mechanical ventilation days was also registered.
Enrolled Patients was assessed for presence of adequate oxygenation, hemoglobin, stable cardiovascular system, metabolic and mental status after Improvement in the underlying condition that leads to acute respiratory failure.
Patients meeting these criteria were weaned in a semi recumbent position, using a two-step weaning protocol (measurements of predictors followed by a spontaneous breathing trial during 30 minutes).
After successful completion of a SBT, patients were extubated, and followed for presence of post-extubation respiratory distress during 48 hours. Extubation failure was defined as need of reintubation in 48 hours.
Blood sample for chromogranin –A was in the first 24hr after invasive mechanical ventilation and measured. Also Vital signs, demographic data, Acute Physiology and chronic Health Evaluation (APACHE II) score at first 24 hours of ICU stay, comorbidities, Glasgow Coma Scale score, days in ICU, MV days were also registered.
The following results were obtained:
• There was no significant difference between the two groups in ( sex,age and comorbities).
• There was significant difference between the two groups in ABG parameters (pH,PaCO2,PaO2,HCO3,SaO2).
• There was significant difference between the two groups in MBP.
• There was significant difference between the two groups in renal function tests.
• There was significant difference between the two groups in APACHE-II score.
• There was significant difference between the two groups in SOFA score.
• There was significant difference between the two groups in GCS.
• There was significant difference between the two groups in ventilator free days and ICU length of stay.
• There was significant difference between the two groups in RSBI.
• There was significant difference between the two groups in liver function tests.
• There was significant difference between the two groups in serum chromogranin-A level.
• There was no significant difference between the two groups in ejection fraction and diastolic dysfunction.
• There was significant difference between the two groups in pulmonary hypertension.
• Serum CgA can be used as predictor of weaning of mechanical ventilation with (sensitivity 83.3% and specificity 77.3%).