以護理人員為主導的實證照護措施於呼吸器脫離之運用

The Evidence-Based Nursing-Led Interventions for Weaning off Mechanical Ventilation

隨著使用呼吸器的時間延長，對病患之身、心、社會等層面將會造成壓力及傷害，如何協助長期使用呼吸器病患成功脫離呼吸器的議題，為醫療團隊的重大挑戰。影響病患長期使用呼吸器的因素甚多，若能清楚探究這些因素，並藉由實證觀點發展有效的介入措施，以幫助病患即早成功脫離呼吸器使用。本文將先行對於呼吸器脫離的定義及分類做清楚的描述，並統整相關影響呼吸器脫離的因素之研究實證，再分別就近期可以護理人員為主導之生理、心理實證介入措施，如──早期復健運動及音樂治療進行分析與討論。冀望此實證討論，能提供醫療團隊作為呼吸器使用病患照護參考與指引，進而協助病患縮短呼吸器使用的時間。

Prolonged mechanical ventilation (PMV) has been proven to cause physiological and psychological trauma for patients. Hence, it is a great challenge for health care providers to facilitate PMV patients weaning from the ventilator. Comprehension of the underline factors leading to the PMV would help to develop the effective intervention and facilitate weaning from mechanical ventilation. This review is started at describing the definition and classification of the ventilator weaning, and its related factors of weaning failure, and further critiquing and synthesizing the prior published evidence-based nursing-led physiological and psychological interventions (e.g., early rehabilitation and music therapy). We anticipate this review can provide the guidance for health care providers to deal weaning difficulty in PMV patients and shorten their length of mechanical ventilation.