- 期刊
運用肺復原於COVID-19重症病患成功脫離呼吸器之呼吸照護經驗
Respiratory Care Experience of Pulmonary Rehabilitation for Weaning of Mechanical Ventilation in a Critically Ill Patient with COVID-19
摘要
本文描述一位老年女性因新冠肺炎快速惡化為急性呼吸衰竭，插管後使用呼吸器及升壓藥的重症照護經驗。因屬新興呼吸道疾病需入住負壓隔離加護病房。除了病毒感染引起之肺炎及呼吸衰竭，病人還需面對疾病預後未知的焦慮，以及長時間臥床後肌力流失的無力感。照護期間為2022年6月10日至2022年6月22日，其主要健康問題為：氣體交換功能障礙、呼吸及四肢肌力下降、痰液清除能力下降及血痰問題。照護期間（1）運用呼吸器輔助以保持穩定通氣系統，改善氧氣供需不平衡狀態；（2）實施床邊上、下肢運動及腹部加壓訓練，進而提升個案四肢及呼吸肌耐力之肺復原運動；（3）輔以胸腔叩擊，教導個案有效咳嗽及姿位引流技巧，同時須留意凝血功能，避免過高抽痰壓力造成的氣道創傷衍生之血痰產生，以利個案清除呼吸道分泌物，最終成功脫離呼吸器；期望藉此照護經驗，探討新冠肺炎重症病人，肺復原介入對呼吸器脫離的影響。
並列摘要
This article describes the nursing experience of caring for an elderly female patient whose condition rapidly deteriorated to acute respiratory failure because of the COVID-19 infection. After being intubated, mechanically ventilated, and administered with vasopressor drugs, she was admitted to a negative pressure isolation intensive care unit due to her deteriorating condition with this emerging respiratory infectious disease. In addition to pneumonia and respiratory failure caused by the viral infection, the patient also experienced anxiety about the unknown prognosis of the disease and weakness due to loss of muscle strength after prolonged bed rest. The nursing period was from June 10, 2022 to June 22, 2022. Her predominant health problems included gas exchange dysfunction, respiratory and limbs muscle weakness, decreased sputum clearance, and bloody sputum. During the nursing period, ventilatory assistance were administered to stabilize the respiratory system, thus mitigating the imbalance between oxygen supply and demand. The patient was assessed for pulmonary rehabilitation, performing upper and lower limb exercises and abdominal pressurization training to increase muscle strength, enhance endurance of respiratory muscles. To facilitate the clearance of airway secretions, the patient was treated by chest percussion, instructed to effectively cough, and use postural drainage techniques. Additionally, attention should be paid to her coagulation function to avoid bloody sputum derived from airway trauma caused by excessive suction pressure. Finally, the patient was successfully weaned from the ventilator. This nursing experience may help in investigating the effect of pulmonary rehabilitation intervention on ventilator disengagement in critically ill patients with COVID-19.