Management of Patients Requiring Prolonged Mechanical Ventilation

長期使用呼吸器病患之處置

劉迪塑(Tissot Low) ； 林宜靜(Yi-Jing Lin) ； 羅春蘭(Chun-Lan Law) ； 林智斌(Chih-Bin Lin)

《內科學誌》 28卷1期 (2017/02) Pp. 24-32

https://doi.org/10.6314/JIMT.2017.28(1).05

摘要

Advances in life-sustaining technologies in critical care have resulted in more survivors from catastrophic illness, yet 4-13% of them fail weaning attempts, sometimes resulting in prolonged dependency on mechanical ventilation. This growing population has drawn much attention not only because of increased healthcare resource utilization, but also because of their poor quality of life and high mortality rate. The management of patients requiring prolonged mechanical ventilation should not be considered an extrapolation from mindsets and studies in the field of critical care. Specialized intermediate care units, respiratory care centers, have been established for comprehensive care of this population, and a growing body of literature in this field has emerged. In this review, we summarize the best available evidence for managing this specific group of patients, including weaning strategies, tracheostomy, nutritional support, and rehabilitation. We also summarize the clinical outcomes and prognostic information from studies based on data from the National Health Insurance Research Database of Taiwan, as this information is important in goal-of-care communication and shared decision making concerning not sustaining ventilator dependency.

關鍵字

Prolonged mechanical ventilation ； Ventilator dependency ； Respiratory care center

並列摘要

隨著重症醫療維生技術的進步，使得許多病患得以從最危急的重症中存活，然而仍有4-13%的病人因無法脫離呼吸器，而最終變成呼吸器依賴。近年來呼吸器依賴人口因日益增加而漸受重視，他們不但耗費可觀的醫療資源，生活品質亦普遍不佳且死亡率甚高。然而，此類病患之照護不應視為重症領域知識及思維之延伸。為了提供完善之呼吸照護，專屬的中期照護機構（如呼吸照護中心）應運而生，且相關領域的研究亦日益累積。本篇將探討長期使用呼吸器病患之照護實證，包括呼吸器脫離策略、氣切、營養及復健等。同時，以台灣健保資料庫為基礎的研究相繼出現，為臨床照護目標溝通及醫病共享決策提供了實用的預後資訊。