Background Mechanical ventilation is a daily event in any ICU, using HFNO as a weaning facilitating strategy for mechanically ventilated patients after passing Spontaneous Breathing Trial (SBT) recently considered to reduce complications associated with invasive ventilation. Objectives To compare high-flow conditioned oxygen therapy versus non -invasive ventilation using continuous positive airway pressure (CPAP) for preventing post-extubation respiratory failure and reintubation in acute exacerbation of chronic obstructive pulmonary disease patients after weaning from mechanical ventilation and to follow patients for ICU and hospital lengh of stay ICU and hospital mortality. Patients and Methods This prospective randomized controlled study, including 60 patients admitted to the intensive care unit at Al- Mataria teaching hospital. Approval of the ethical committee of Al-Mataria teaching hospital was obtained before the start of patient’s recruitment. Patients who successfully extubated were equally randomized (sequential) to enter either group I or group II. Study group (I): included 30 patients subjected to high flow nasal oxygen after extubation for 24 hrs. Control group (II): included another 30 patients on non-invasive CPAP after extubation for 24 hrs. Results Our results showed lower rate of reintubation in HFNO group (n = 6) 20%, compared to NIV group(n = 7) 23. 3 %, higher PaO2 in HFNO group immediate, 2 hrs post extubation. No significant differences found regarding mortality rate between both study groups (8/30) 26. 6 % in HFNO group, while (9/30) 30 % in NIV group, p (Ns). Arterial PH was significantly lower in NIV group immediately after extubation. Conclusion HFNO compared to NIV alone showed lower rate of reintubation when used immediately after planned extubation. Patients weaned using HFNO showed higher PaO2 2hrs postextubation. HFNO compared to NIV alone didn’t affect hospital stay.

Objective: The present study was designed to investigate cardio-respiratory disorders among sewage workers in Alexandria in order to suggest the suitable preventive measures for this sector. Materials and Methods: This study was conducted on 67 male sewage workers and a control group of 60 non-exposed matched persons. All participants of the study were subjected to an interview using a pre-designed questionnaire and clinical general and systemic examinations as well as specific investigations including resting ECG, pulmonary function testing, plain chest X-ray and measurement of the level of sulf-hemoglobin. Results: This study showed high smoking rate among sewage workers in comparison to controls (p=0.010). The resting ECG changes reported among the exposed workers in the present study were mainly left ventricular hypertrophy (LVH) and ischemic changes (p=0.027). Sulf-hemoglobin level was an independent determinant factor in multiple logistic regression models with LVH and ischemic changes as the dependent variables (p= 0.050 and 0.000 respectively). Significant reductions in percent predicted FVC and FEV1 among the exposed group versus controls (p=0.000 and 0.001 respectively), suggesting a restrictive pattern of impairment, were observed. Respiratory manifestations were the independent determinant for FVC and FEV1 in multiple regression analyses (p= 0.031 & 0.05 respectively). Conclusion: Cardio-respiratory disorders among sewage workers should be considered in health surveillance of this sector with emphasis on antismoking measures.

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