Title

多元創意衛教策略對呼吸器依賴主要照顧者之氣切認知與態度影響探討

Translated Titles

Exploring the impact of multiple-creative health education strategy on cognition and attitude of tracheostomy for the caregiver of prolonged mechanical ventilation patient

DOI

10.6834/csmu202100041

Authors

朱嫦智

Key Words

呼吸器依賴 ; 多元創意衛教策略 ; 氣切 ; 認知 ; 態度 ; Prolonged mechanical ventilation ; Multi-creative health education strategy ; Tracheostomy ; Cognition ; Attitude

PublicationName

中山醫學大學護理系長期照護碩職專班學位論文

Volume or Term/Year and Month of Publication

2021年

Academic Degree Category

碩士

Advisor

郭青萍

Content Language

繁體中文

Chinese Abstract

背景與目的:據健保署2017年統計顯示,長期呼吸依賴(prolonged mechanical ventilation, PMV)醫療支出每年約140億,其醫療支出僅次於癌症,位居第二名。實證研究發現早期氣切,可提高呼吸器脫離率及降低肺炎及死亡的發生率,然台灣執行氣切的醫療決策大多仰賴主要照顧者。因此,本研究針對呼吸器依賴者及其主要照顧者的基本特性、呼吸器依賴疾病特性、運用多元創意衛教策略介入後,主要照顧者對氣切手術認知及態度的分佈,並進行分析介入前後影響主要照顧者對氣切認知與態度的相關及影響因素。. 方法:研究採單組前後測實驗設計,以中山醫學大學附設醫院為收案地點,於2019年11月至2020年11月間,針對家屬插管大於21天且短暫無法脫離呼吸器之主要照顧者為對象,共完成34位收案。研究介入前以「呼吸器依賴主要照顧者對執行氣切認知與態度」量表進行前測,接著進行多元創意衛教策略介入,並於介入後一星期以同樣量表進行後測。回收資料以SPSS 22.0套裝軟體進行統計分析。 結果:多元創意衛教介入前後的認知(t =4.21±4.08,p<.00)與態度 (t=7.5±7.02,p<.00)差異比較,皆達統計上顯著。而疾病診斷不同會造成主要照護者對氣切手術之認知,在介入前(p=.03)及前後差(p=.04)皆有顯著差異。經事後比較發現呼吸器依賴者為神經/意外損傷診斷時,其主要照護者在介入前對氣切手術之認知分數顯著高於呼吸器依賴者為呼吸系統及腦心血管診斷者;女性在氣切態度改變分數的前後差,皆顯著大於男性(p=.00)。主要照顧者之年齡及子女數、教育程度等變項,對主要照顧者執行氣切手術態度之影響,在介入前、介入後及前後差,皆未達顯著差異水準(p=.25~.77)。 結論與建議:隨著資訊科技日新月異的進步,發展出有別於傳統紙本的多元創意衛教策略。本研究運用影音媒體、體驗及同理心活動、提供單張及幫助記憶之順口溜等多元創意衛教方案的介入,能顯著提升主要照顧者對執行氣切手術的認知與態度。此研究結果有助於醫護人員日後執行氣切手術衛教時之參考依據,藉此提升呼吸依賴之主要照顧者,對氣切手術有正確的觀念,進而能改善病人的生活品質。

English Abstract

Background and Purpose:According to the statistics from the national health insurance agency in 2017, the annual expenditure for treating prolonged medical ventilation (PMV) patients was about 14 billion NTD, this expenditure was second only to the expenditure of treating the patients with cancer. The evidenced study had found that early tracheostomy could increase the chance of ventilator detachment and decrease the incidence of pneumonia and death. However, we’ve found that whether to undertake the tracheostomy depends heavily on the caregivers instead of the patients themselves. Therefore, this study intervenes with multi-creative health education strategies based on the characteristic of the patients and their primary caregivers and also the characteristic of the respirator depend. We analyze the primary caregiver’s cognition and attitude towards tracheostomy before and after the multi-creative health education strategy is intervened. We also search for the factors that affect the primary caregiver’s cognition and attitude towards tracheostomy. Method:A one-group pre-posttest experiment study design was adopted. Starting from November 2019 to December 2020, the study was conducted at Chung Shan Medical University Hospital (CSMUH). Targeting the patients who have been intubated for more than 21 days and were temporarily unable to detach the respirator, 34 participants (caregivers) had included. Before the intervention, the pre-test was conducted on the scale of “The caregiver’s cognition and attitude towards tracheostomy”, the post-test was conducted on the same scale one week after the intervention. Using the SPSS 22.0 software for data analysis. Results:The results shown that there was a statistically significant difference in the caregiver’s cognition(t =4.21±4.08,p<.00) and attitude(t =7.5±7.02,p<.00) towards tracheostomy, before and after the creative health education was intervened. Conclusions / Implications for Practice:The advancement of information technology rapidly, a diversified creative health education strategy different from traditional paper has been developed. We had used the multi-creative health education programs, including audio-visual media, experience and empathy activities, provision of leaflets, and jingle to help memory regarding the tracheostomy. The strategies mentioned above could be useful, as a reference for the medical staff when performing health education to the patients who rely on respirators and their caregivers. The strategies will promote the correctness of caregivers' concepts of tracheostomy, and improve the quality of life of patients.

Topic Category 醫藥衛生 > 社會醫學
醫學院 > 護理系長期照護碩職專班
Reference
  1. 中文文獻
  2. 于博芮、胡文郁、胡月娟、周守民、吳韻淑、羅筱芬、李惠玲(2012).成人內外科護理 (五版).台北市:華杏。[Yu, PJ, Hu, WY, Hwu, YJ, Chou, SM, Wu, Y. S., Lo, SF,... Lee, HL (2012). Adult health nursing . Taipei City, Taiwan, ROC: Farseeing.]
  3. 王娜娜、陳宏一、鄭愛琴、紀宗呈、陳欽明、紀宗利(2015).呼吸衰竭病人延遲脫離的影響因子初探.醫務管理期刊,16(3),205-221。
  4. 王淑珍、劉瑞芳、王淑慧、王金洲、李英俊(2013).長期呼吸器依賴病患之主要照顧者負荷與需求探討-以南區呼吸照護病房與居家照護為例.呼吸治療,12(2),1-15。
  5. 王瑪麗、柯政昌、賴超倫、林綉玲、林麗芬(2015).衛教指導對於呼吸器依賴患者家屬選擇慢性呼吸照護病房或是居家照護之影響.呼吸治療,14(2),38-38。
  6. 古世基、余忠仁. (2010).台灣地區呼吸器依賴患者醫療體系及病患照護之回顧.重症醫學雜誌,11(1),25-31。
  7. 江吉文、徐秀娥、黃耀斌、鄭裕民(2013).從實證醫學觀點探討長期使用呼吸器之重症病人氣切的時機.醫學與健康期刊,2(1),13-19。
  8. 何肇基(2008).氣切的誤解與迷思.健康世界,(265),10-11。
  9. 吳沼漧、張谷州、黃裕靜、沈連喜、高旭卿、王逸熙、劉世豐、王金洲、林孟志(2015).APACHE Score Used in Predicting Weaning Outcomes in an Intermediate Respiratory Care Center [Apache分數系統用來預測呼吸照護中心病患預後].胸腔醫學,30(5),271-279。
  10. 吳英旬、曾月霞(2009).呼吸器居家病人家屬照顧者之生活經驗.長期照護雜誌,13(2),169-189。
  11. 吳純怡、陳瑞貞(2018).運用醫病共享決策於氣切手術抉擇衝突.[Application of Shared Decision Making for Tracheostomy in an ICU Patient with Decision Conflict] .台灣醫學,22(6),593-598. https://doi.org/10.6320/fjm.201811_22(6).0003
  12. 吳國湘、蕭自佑、古世基、陳佳慧(2014).長期經口氣管插管在口腔、咽喉及氣管之合併症.台灣醫學18(5),580-584。
  13. 吳緒慧(2020).【論文摘要】氣切對長期呼吸器依賴患者是否能降低使用呼吸器與住院天數【論文摘要】Dose tracheotomy to the patients with mechanical ventilation that can reduce ventilator days and hospitalization days?].呼吸治療,19,51-52. https://doi.org/10.6269/jrt.202010/sp_19.0030
  14. 呂雀芬、吳淑美、徐瑩媺、葉美玉(2018).遊戲式學習於護理教育應用-同理心桌遊教學.[Applying Game-Based Learning in Nursing Education: Empathy Board Game Learning].護理雜誌,65(1),96-103. https://doi.org/10.6224/jn.201802_65(1).13
  15. 李彥錚、歐軒如、卓知穎、王琬詳(2018).提升留置導尿管相關膀胱不適護理處置完整率.[Improve Intact Rates of Nursing Interventions for Catheter-Related Bladder Discomforts].志為護理-慈濟護理雜誌,17(4),91-104。
  16. 李秋譁、馬震中、王建仁、陳俊道、丘周萍(2018).不同護理衛教方式對手術後病人使用自控式止痛之成效.[Comparing the Effectiveness of Different Health Education Methods for Teaching Postoperative Patients About Patient-Controlled Analgesia].榮總護理,35(2),136-144. https://doi.org/10.6142/vghn.201806_35(2).0003
  17. 李淑菁(2017).[體驗]作為多元文化教育的一種方式:內涵與實踐教育脈動.(12)1-9-003。
  18. 李惠英(2016).運用食物圖片單張輔助個別化營養衛教對慢性腎臟病患之營養知識、態度及行為成效.中山醫學大學營養學研究所學位論文,1-78。
  19. 李惠英、劉怡俊、吳怡雯、林妍君、陳香吟、林娉婷(2016).運用食物圖片教材輔助個別化營養教育對慢性腎臟病人之飲食知識、態度、行為成效。[Effect of Using Food Pictures in Individualized Nutrition Education on the Nutritional Knowledge, Attitudes, and Behavior in Patients with Chronic Kidney Disease].臺灣營養學會雜誌,41(1),25-39. https://doi.org/10.6691/nsj.201603_41(1).0003
  20. 李綺婷、陳志成、葉俊濬、李英俊(2011).呼吸器依賴病患再插管的影響因子 [Factors Associated with Reintubation on Ventilator-dependent Patients].呼吸治療.10(2),74-74. https://doi.org/10.6269/jrt.2011.10.2.22
  21. 沈連喜、洪惠苓、張永源、鍾聿修、杜美蓮、薛玫玲(2011).影響長期呼吸器依賴病患留置因素與整合式照護之成效分析-以南部某醫學中心為例 [Factors Related to Long-term Ventilator-Dependent Patients and the Effectiveness of the Integrated Delivery Managed Care-One Medical Center as Example].呼吸治療,10(2), 78-78. https://doi.org/10.6269/jrt.2011.10.2.26
  22. 沈翠蓮(2015).創意原理與設計.台灣五南圖書出版股份有限公司。
  23. 林育姿、黃建寧、王威傑、李靜茹、吳月珠、蕭惠文、楊宜瑱 (2017).糖尿病對話卡與團體衛教介入對第二型糖尿病注射基礎型胰島素病人血糖控制成效之探討 [Diabetes Education Intervention for Type 2 Diabetic Patient with Basal Insulin Therapy].台灣家庭醫學雜誌,27(2),65-76. https://doi.org/10.3966/168232812017062702001
  24. 林姵妘、林淑華、林筱芳. (2017).運用創意衛教模式提升血液透析病人對高磷飲食之認知.臺灣腎臟護理學會雜誌,16(2),44-59。
  25. 林姿君(2010).消費者對平價奢華態度之量化研究.
  26. 林紋麗、吳佩樺、孫嘉玲、張雅萍、陳淑銘(2011).比較不同鼻胃管灌食衛教方式對病患家屬於知識及焦慮之成效.高雄護理雜誌,28(2),7-21。
  27. 林純麗、謝素英、許麗齡(2017).建構護理人員對呼吸器依賴患者長期照護知識之在職教育需求量表.長庚護理,28(1),12-24。
  28. 林琇玲、林冠語(2016).合併成功案例之多媒體衛教光碟介入對首次接受脊椎手術病人術前焦慮之成效.嘉基護理,16(1),1-13。
  29. 林曉佩、陳嘉銘、許淑純陳怡均(2013).長期使用呼吸器患者早期氣切較晚期氣切效益探討.醫學與健康期刊,2(1),21-29。
  30. 林麗卿、邱艶芬、林碧珠(2017).家屬叮嚀方案對減輕加護病人焦慮和非計畫性拔管之成效 [The Effect of Family Member Reminders on Reducing Anxiety and Unplanned Extubation in ICU Patients].護理雜誌,64(5),41-49. https://doi.org/10.6224/jn.000067
  31. 邱啟潤、許淑敏、吳瓊滿(2002).主要照顧者負荷、壓力與因應之國內研究文獻回顧 [Literature Review of Primary Caregivers' Burden, Stress and Coping in Taiwan Research].醫護科技學刊,4(4),273-290. https://doi.org/10.6563/tjhs.2002.4(4).1
  32. 柯碧芬、陳雅惠、黃惠美、劉道英、詹明澄、黃彥翔(2019).提升加護病房呼吸器依賴病人家屬之氣切認知率.澄清醫護管理雜誌,15(3),64-73。
  33. 洪小惠(2010).呼吸器依賴病患家屬拒行氣切的覺知蛻變歷程.高雄醫學大學護理學系研究所學位論文,1-108。
  34. 范心盈、林嘉慈、張幸惠、李明靜(2013).呼吸照護病房醫人員對家屬考量氣切因素認知相關探討─以雲林地區某醫院為例.
  35. 范姜玉珍、顏雅卉、陳淑雯(2019).護理指導資訊化輔助降低導尿管及非導管之泌尿道感染率之改善專案.[Using Nursing Digital Technology to Reduce the Rates of Catheter-Associated and Non-Catheter-Associated Urinary Tract Infection].護理雜誌,66(2),77-84. https://doi.org/10.6224/jn.201904_66(2).10
  36. 翁敏雪、李靜怡(2008).早期氣切與晚期氣切之預後分析.生活科學學報,12,195-205。
  37. 張旭良、楊志仁、洪仁宇、洪加芬、蘇育正、鍾飲文、黃吉志、黃明賢、許超群、蔡忠榮 (2013).經皮氣管切開術在加護病房重症患者的運用.內科學誌,24(3),153-161。
  38. 張春興(1988).知之歷程與教之歷程:認知心理學的發展及其在教育上的應用.認知與學習研討會專輯 (第二次).台北市:行政院國家科學委員會.連結.
  39. 莊孟蓉、曾鳳美、李雅芬、洪麗娟(2016).非計劃性氣管內管拔管發生率改善專案 [Reducing the Incidence of Unplanned Extubation]醫務管理期刊,17(2),115-130。https://doi.org/10.6174/jhm2016.17(2).115
  40. 陳凱莉、 陳清惠(2014).台灣老人醫療自主權的省思.護理雜誌,61(5),26-32。
  41. 陳惠珍、謝文斌(2002).長期使用呼吸器病人的照護問題.當代醫學,(347)753-760。 https://doi.org/10.29941/mt.200209.0014
  42. 陳智宏、胡強華、劉家福、孫卓卿(2003).經皮氣管切開術 (percutaneous tracheostomy).基層醫學,18(4),100-103。
  43. 陳嘉容、許芬萍、方素瓔(2019).外科加護病房病人使用氣管內管不適症狀與護理處置.台灣醫學,23(3),287-297。
  44. 陳慧秦、王秀紅(2014).氣切照護管理運用在呼吸器依賴病人的文獻評析.長庚科技學刊(21),25-38。
  45. 陳慧秦、宋立信、張新傑、許敏桃(2016).Factors related to tracheostomy timing and ventilator weaning: findings from a population in Northern Taiwan.
  46. 陳慧秦、鄭文輝、林孟志(2008).由家屬的角度探討長期呼吸器依賴患者的照護問題 [Care Needs of Long-term Ventilator-dependent Patients from Perspectives of Family Members]呼吸治療,7(2),1-19。 https://doi.org/10.6269/jrt.2008.7.2.01
  47. 黃英哲、曾梓維、洪鴻龍(2017).各種經皮氣切術的比較.北市醫學雜誌,14(3),289-294。
  48. 黃雅萱、許麗齡(2012).臨床教學創作—主動脈氣球幫浦標準技術流程 [Clinical Teaching Program: Standardized Operating Procedure for Intra-Aortic Balloon Pump Support].護理雜誌,59(4),88-93. https://doi.org/10.6224/jn.59.4.88
  49. 楊思雋、陳昌文、張漢煜(2011).如何評估使用呼吸器病人的做功狀態.內科學誌,22(2),91-98。
  50. 楊嘉玲、孫惠玲(2003).[照顧者負荷] 概念分析.馬偕護理專科學校學報(3),15-27。
  51. 葉如芳、葉肅科、惠群(2015).呼吸照護病房末期病人主要照顧者的類型.台灣醫學9(2),188-196。
  52. 葛樹人(1988).台北: 桂冠圖書公司
  53. 潘裕豐(2006).為何及如何做創意教學.生活科技教育,39(2)3,8-55。
  54. 鄭巧玲(2015).影響主要決策者對呼吸器困難脫離病人氣切決策之相關因素探討.高雄醫學大學護理學系碩士班學位論文1-99。
  55. 鄭玉欣、劉安祥、劉怡、陳幸眉(2016).腦瘤手術前病人的主要照顧者之照護需求及相關因素之探討.護理雜誌,63(3),31-41。
  56. 鄭雅君(2017).貼心衛教、強化溝通.志為護理-慈濟護理雜誌,16(1),30-31。
  57. 衛生福利部台灣病人安全資訊網:醫病共享決策學習平台。取自:https://sdm.patientsafety.mohw.gov.tw/
  58. 衛生福利部中央健康保險署(2021,1月15日)呼吸器依賴患者整合性照護試辦計畫https://www.nhi.gov.tw/Content_List.aspx?n=A27FC07E1D6ACC13 topn=5FE8C9FEAE863B46
  59. 賴宜萍、簡麗娜、王瀅如、李維玲(2016).應用QR code衛教影片提升兒童牙科病人刷牙成效.
  60. 賴美玉、陳玉如、游顯妹(2015).接受氣切病人生活品質改變及主要照顧者認知感受之初探 [The Change of Quality of Life in Patients with Tracheostomy and their Primary Caregiver’s Cognitive Perception: A Preliminary Study].源遠護理,9(3),27-36. https://doi.org/10.6530/yyn/2015.1.03。
  61. 鍾若男 (2003).住院氣管造口病患家屬需求及其影響因素探討.
  62. 藍春鳳、張美玉、吳杰亮、鄭桂鳳、黃智傑、林泰綜、王玉玲(2006).內科呼吸衰竭病人氣管內插管留置時間改善專案.榮總護理,23(3),310-318。
  63. 蘇思憓、吳麗敏(2018).重症病患決策代理人之醫療決策行為意向及其相關因素探討 [The Intentions Affecting the Medical Decision-Making Behavior of Surrogate Decision Makers of Critically Ill Patients and Related Factors].護理雜誌,65(2),32-42。https://doi.org/10.6224/jn.201804_65(2).06
  64. 蘇柏嵐、張漢煜(2015).死腔通氣:無效的呼吸!內科學誌,26(2),69-76。
  65. 蘇鈺雯(2008).家屬對長期使用呼吸器患者氣切之決定過程.長榮大學護理學系(所)學位論文,1-108。
  66. 英文文獻
  67. Adly, A., Youssef, T. A., El-Begermy, M. M., Younis, H. M. (2018). Timing of tracheostomy in patients with prolonged endotracheal intubation: a systematic review. European Archives of Oto-Rhino-Laryngology, 275(3), 679-690. https://link.springer.com/content/pdf/10.1007/s00405-017-4838-7.pdf
  68. Ambrosino, N., Vitacca, M. (2018). The patient needing prolonged mechanical ventilation: a narrative review. Multidisciplinary respiratory medicine, 13(1), 1-10.
  69. Andriolo, B. N., Andriolo, R. B., Saconato, H., Atallah, Á. N., Valente, O. (2015). Early versus late tracheostomy for critically ill patients. Cochrane database of systematic reviews(1).
  70. Asehnoune, K., Roquilly, A., Cinotti, R. (2018). Respiratory management in patients with severe brain injury. Annual Update in Intensive Care and Emergency Medicine 2018, 549-558.
  71. Bice, T., Nelson, J. E., Carson, S. S. (2015). To Trach or Not to Trach: Uncertainty in the Care of the Chronically Critically Ill. Semin Respir Crit Care Med, 36(6), 851-858. https://doi.org/10.1055/s-0035-1564872
  72. Chandrasheker, Y., Viswanatha, B., Srinivasan, S. B., Jayaram, R. T., Vijayashree, M. S. (2016). Tracheostomy in Intensive Care Unit: Indications and outcomes at a teaching hospital. Research in Otolaryngology, 5(2), 28-31.
  73. Chen, H. C., Song, L., Chang, H. C., Hsu, M. T. (2018). Factors related to tracheostomy timing and ventilator weaning: findings from a population in Northern Taiwan. The clinical respiratory journal, 12(1), 97-104. https://onlinelibrary.wiley.com/doi/abs/10.1111/crj.12492
  74. Chen, W.-L., Chen, C.-M., Kung, S.-C., Wang, C.-M., Lai, C.-C., Chao, C.-M. (2018). The outcomes and prognostic factors of acute respiratory failure in the patients 90 years old and over. Oncotarget, 9(6), 7197. https://www.oncotarget.com/article/24051/pdf/
  75. Cheung, N. H., Napolitano, L. M. (2014). Tracheostomy: Epidemiology, Indications, Timing, Technique, and OutcomesDiscussion. Respiratory care, 59(6), 895-919. http://rc.rcjournal.com/content/respcare/59/6/895.full.pdf
  76. Collins, L. G., Swartz, K. (2011). Caregiver care. Am Fam Physician, 83(11), 1309-1317. https://www.aafp.org/afp/2011/0601/afp20110601p1309.pdf
  77. Dochi, H., Nojima, M., Matsumura, M., Cammack, I., Furuta, Y. (2019). Effect of early tracheostomy in mechanically ventilated patients. Laryngoscope investigative otolaryngology, 4(3), 292-299. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6580064/pdf/LIO2-4-292.pdf
  78. Durbin, C. G. (2005). Indications for and timing of tracheostomy. Respiratory care, 50(4), 483-487. http://rc.rcjournal.com/content/respcare/50/4/483.full.pdf
  79. http://rc.rcjournal.com/content/50/4/483.short
  80. Enguidanos, S., Housen, P., Penido, M., Mejia, B., Miller, J. A. (2014). Family members’ perceptions of inpatient palliative care consult services: A qualitative study. Palliative Medicine, 28(1), 42-48. https://doi.org/10.1177/0269216313491620
  81. Freeman, B. D. (2017). Tracheostomy update: when and how. Critical care clinics, 33(2), 311-322. https://www.criticalcare.theclinics.com/article/S0749-0704(16)30119-1/fulltext
  82. Germain, C. P. (1992). Cultural care: A bridge between sickness, illness, and disease. Holistic Nursing Practice, 6(3), 1-9. https://journals.lww.com/hnpjournal/Fulltext/1992/06030/Cultural_care__A_bridge_between_sickness,_illness,.4.aspx
  83. Hebert, L. M., Watson, A. C., Madrigal, V., October, T. W. (2017). Discussing Benefits and Risks of Tracheostomy: What Physicians Actually Say. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 18(12), e592-e597. https://doi.org/10.1097/PCC.0000000000001341
  84. Hemmati, H., Forozeshfard, M., Hosseinzadeh, B., Hemmati, S., Mirmohammadkhani, M., Bandari, R. (2017). Tracheostomy in Patients Who Need Mechanical Ventilation: Early or Late? Surgical or Percutaneous? A Prospective Study in Iran. Indian Journal of Surgery, 79(5), 406-411. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5653573/pdf/12262_2016_Article_1497.pdf
  85. Hosokawa, K., Nishimura, M., Egi, M., Vincent, J.-L. (2015). Timing of tracheotomy in ICU patients: a systematic review of randomized controlled trials. Critical Care, 19(1), 1-12.
  86. Hsu, C.-L., Chen, K.-Y., Chang, C.-H., Jerng, J.-S., Yu, C.-J., Yang, P.-C. (2004). Timing of tracheostomy as a determinant of weaning success in critically ill patients: a retrospective study. Critical Care, 9(1), 1-7.
  87. Hsu, H.-K., Chen, C.-J. (2018). Promoting the Effectiveness of Tracheostomy Nursing Instruction in the Intensive Care Unit.
  88. Huang, H., Li, Y., Ariani, F., Chen, X., Lin, J. (2014). Timing of tracheostomy in critically ill patients: a meta-analysis. PloS one, 9(3), e92981. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3965497/
  89. Ju, M., He, H., Zheng, Y., Tu, G., Xuan, L., Ma, J., Luo, J., Zhu, D., Luo, Z., Cang, J. (2017). Tracheostomy in critically ill Chinese patients: propensity score matching analysis to determine indication and timing. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL MEDICINE, 10(5), 7890-+.
  90. Keeping, A. (2016). Early versus late tracheostomy for critically ill patients: a clinical evidence synopsis of a recent Cochrane Review. Canadian journal of respiratory therapy: CJRT= Revue canadienne de la therapie respiratoire: RCTR, 52(1), 27. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4751969/pdf/cjrt-52-27.pdf
  91. Khammas, A. H., Dawood, M. R. (2018). Timing of tracheostomy in intensive care unit patients. International archives of otorhinolaryngology, 22(4), 437-442. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6197980/pdf/10-1055-s-0038-1654710.pdf
  92. https://www.thieme-connect.com/products/ejournals/pdf/10.1055/s-0038-1654710.pdf
  93. Kher, A., Johnson, S., Griffith, R. (2017). Readability assessment of online patient education material on congestive heart failure. Advances in preventive medicine, 2017.
  94. Liu, J.-F., Lu, M.-C., Fang, T.-P., Yu, H.-R., Lin, H.-L., Fang, D.-L. (2017). Burden on caregivers of ventilator-dependent patients: A cross-sectional study. Medicine, 96(27), e7396-e7396. https://doi.org/10.1097/MD.0000000000007396
  95. Longworth, A., Veitch, D., Gudibande, S., Whitehouse, T., Snelson, C., Veenith, T. (2016). Tracheostomy in special groups of critically ill patients: Who, when, and where? Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine, 20(5), 280.
  96. MacIntyre, N. R., Epstein, S. K., Carson, S., Scheinhorn, D., Christopher, K., Muldoon, S. (2005). Management of patients requiring prolonged mechanical ventilation: report of a NAMDRC consensus conference. Chest, 128(6), 3937-3954. https://journal.chestnet.org/article/S0012-3692(15)49639-4/fulltext
  97. Meng, L., Wang, C., Li, J., Zhang, J. (2016). Early vs late tracheostomy in critically ill patients: a systematic review and meta‐analysis. The clinical respiratory journal, 10(6), 684-692. https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/crj.12286?download=true
  98. Mu, Z., Zhang, Z. (2019). Risk factors for tracheostomy after traumatic cervical spinal cord injury. Journal of Orthopaedic Surgery, 27(3), 2309499019861809. https://doi.org/10.1177/2309499019861809
  99. Muzaffar, S. N., Gurjar, M., Baronia, A. K., Azim, A., Mishra, P., Poddar, B., Singh, R. K. (2017). Predictors and pattern of weaning and long-term outcome of patients with prolonged mechanical ventilation at an acute intensive care unit in North India. Revista Brasileira de terapia intensiva, 29(1), 23. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5385982/pdf/rbti-29-01-0023.pdf
  100. Sleurs, K., Seys, S. F., Bousquet, J., Fokkens, W. J., Gorris, S., Pugin, B., Hellings, P. W. (2019). Mobile health tools for the management of chronic respiratory diseases. Allergy, 74(7), 1292-1306.
  101. Su, S.-H., Wu, L.-M. (2018). 重症病患決策代理人之醫療決策行為意向及其相關因素探討. Hu Li Za Zhi, 65(2), 32-42.
  102. Walikar, B., Pandit, A., Rashinkar, S., Watwe, M., Yashaswini, K. (2018). Current research trends comparing percutaneous dilatational tracheostomy and conventional surgical tracheostomy: a systematic review. Int J Otorhinolaryngol Head Neck Surg, 4, 1121-1124.
  103. Wu, Y.-K., Tsai, Y.-H., Lan, C.-C., Huang, C.-Y., Lee, C.-H., Kao, K.-C., Fu, J.-Y. (2010). Prolonged mechanical ventilation in a respiratory-care setting: a comparison of outcome between tracheostomized and translaryngeal intubated patients. Critical Care, 14(2), 1-7.
  104. Yuan, C.-R., Lan, T.-Y., Tang, G.-J. (2015). Can Tracheostomy Improve Outcome and Lower Resource Utilization for Patients with Prolonged Mechanical Ventilation? Chinese medical journal, 128(19), 2609. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4736850/pdf/CMJ-128-2609.pdf
  105. Zamanipoor Najafabadi, A. H., van der Meer, P. B., Boele, F. W., Taphoorn, M. J. B., Klein, M., Peerdeman, S. M., van Furth, W. R., Dirven, L., Dutch Meningioma, C. (2020). The long-term caregiver burden in World Health Organization grade I and II meningioma: It is not just the patient. Neuro-oncology advances, 3(1), vdaa169-vdaa169. https://doi.org/10.1093/noajnl/vdaa169