我國人工呼吸道照護安全現況調查

Artificial Airways Safety-A Survey on Current Situations

賴俊仰(Chun-Yang Lai) ； 王拔群(Pa-Chun Wang) ； 吳錦桐(Jin-Tung Wu) ； 邱銘煌(Ming-Huang Chiu) ； 黃鈞鴻(Chun-Hung Huang) ； 張燕良(Yen-Liang Chang)

《台灣耳鼻喉頭頸外科雜誌》 41卷2期 (2006/04) Pp. 51-65

https://doi.org/10.6286/2006.41.2.51

摘要

背景：人工呼吸道的設置是急重症加護單位內最基本的侵入性處置。然而，不當的人工呼吸道照護可能引發嚴重的合併症，因此，如何促進人工呼吸道照護安全是維護病人及促進醫療品質的目標。
方法：針對全國各層級醫院之急重症加護單位醫師發出「人工呼吸道照護安全」現況調查問卷。調查結果以百分比呈現，並進行相關度以及危險因子分析。
結果：胸腔暨重症專科醫師為我國急重症加護單位第一線照顧病人的中堅主力(62.6%)。多數的急重症加護單位除了常規的氣管內插管設備外，還備有人工呼吸道急救設備器械組（如纖維內視鏡及氣切包等，73.7%）。50%以上的急重症加護單位都制定有人工呼吸道緊急狀況處理的標準處理程序。非氣切病患發生人工呼吸道意外最常見的原因為：非計畫性拔管(85.4%)；而氣切病患則以呼吸器管路與氣切管分離滑脫(46.0%)最為常見。多數的受訪者認為無法及時建立診斷及未採取正確之醫療處置程序是發生人工呼吸道意外時造成患者二度傷害或死亡最常見的原因(55.6%)，而這與醫護人員經驗不足有關(50%)。67.2%受訪者認為，人工呼吸道意外是可以事先預防，而認為可以立即有效處理的佔82.3%。
結論：本國人工呼吸道照護安全的促進，仍以加強教育訓練以及引進醫療品質管理為迫切需要進行的工作。

關鍵字

人工呼吸道 ； 病人安全 ； 醫療品質

並列摘要

OBJECTIVES: The government-sponsored project investigates the current situations of artificial airways (mainly endotracheal intubation and tracheostomy) safety in the intensive care units of Taiwan's hospitals. We report the prevalence of adverse events and the appropriateness of care.
MATERIALS & METHODS: An ”Artificial Airways Safety Survey” was designed through standard questionnaire development processes including pre-test, post-test, and expert validity test. Informations were collected through postal survey in a prospective, blinded fashion from pulmonary and critical care specialists in the country. The opinions and perceptions of responders were submitted anonymously through traditional mail.
RESULTS: A total of 2,236 surveys was administered with 198 responses (return rate 8.9%) available for analysis. Around 75% of responders are aged 36-60 years and the gender ratio is 7:1 (male : female). More than half of the responders (73.7%) have intensive care experiences longer than 4 years. The staffing ratio is 10 to 20 (28.3%) patients per physician, or 1 to 10 (85.4%) patients per nurse in common intensive care settings, Most of the intensive care units (60.6%) have some sorts of established ”standard of operation” to cope with airway emergency. ”Self-extubation” (85.4%), ”airway obstruction” (60.6%) and ”disconnection” (38.9%) rank as the commonest types of endotracheal intubation adverse events; while as ”disconnection” (46.0%), ”wound infection” (40.0%) and ”obstruction” (38.4%) rank as the commonest types of tracheostomy adverse events. Major consequences of artificial airway adverse event in their hospital were heard by 30.8% of physicians during the past year.
CONCLUSIONS: Security of artificial airways is essential for patients who need assisted ventilation. Establishment of the standard of operation to care patients can prevent artificial airway accidents from happening. Frequent, regular education and training for the staffs can reduce the secondary injury or mortality when accidents do happen.

並列關鍵字

artificial airways ； patient safety ； healthcare quality