某區域醫院非侵襲性呼吸器在適應症外使用現況

Current Status of Off-Label Use of Non-Invasive Ventilator at a Regional Hospital in Taiwan

探討適應症外（off-label use）的使用非侵襲性呼吸器（NIV）病人之現況分析。採電子病歷回溯性調查設計，以2013年8月1日至2015年12月31日（共29個月）住院中因適應症外的使用非侵襲性呼吸器個案進行分析。適應症外使用NIV病人共449位，其中非癌病人共326位（佔72.6%），癌症病人123位（佔27.4%）。平均年齡為75.03歲（SD=13.97）、建議平均使用天數為5.80天（SD=6.03）、平均住院天數為19.97天（SD=15.42）。而非癌病人在不施行心肺復甦術（DNR）討論（56.4%vs.73.2%；p=0.001）、不予插管（DNI）（23.3vs.43.9；p<0.001）、緩和鎮靜藥物使用（1.2%vs.44.7%；p<0.001）及住院中死亡（27.9%vs.63.4%；p<0.001）之比率皆顯著較癌症病人為低。比較適應症外的使用NIV病人之狀態中發現以非癌病人在意識不清下使用NIV者顯著高於癌症病人（52.8%vs.35.8%；p=0.001）。因適應症外的使用NIV者以非癌病人居多，且有五成是在意識不清之情況下使用，但其死亡率近三成，而在緩和鎮靜藥物的使用卻極少（1.2%），因此建議醫療人員應在非癌病人意識清楚時即與病人及家屬詳盡說明維生醫療（如NIV）之優劣，並為達到緩和鎮靜效果之下適當使用藥物，避免病人受苦。 Abstract: The objective of the present study was to investigate the characteristics of patients who received off-label us of non-invasive ventilator (NIV) therapy during 1 Aug., 2013 to 31 Dec., 2015(29 months in total). The electronic medical records of these patients were retrospectively reviewed and analyzed. Among the enrolled 449 patients, 326 are non-cancer patients (72.6%), and 123 are cancer patients (27.4%). The average age is 75.03 years (SD=13.97), average NIV period is 5.80 days (SD=6.03), average hospitalized period is 19.97 days (SD =15.42). For non-cancer patients, the percentage of “Do Not Resuscitate (DNR)” discussion (56.4% vs.73.2%; p=0.001), “Do Not Intubation (DNI)” (23.3% vs 43.9%; p<0.001), adoption of palliative sedations (1.2% vs. 44.7%; p<0.001), and death during hospitalization (27.9% vs.63.4%; p<0.001) are all significantly less than those of cancer patients. The percentage of adopting NIV therapy under unconsciousness among non-cancer patients is significantly higher than that of cancer patients (52.8% vs. 35.8%; p=0.001). The fatality rate among non-cancer patients who received off-label NIV therapy under unconsciousness is nearly 30%, and the adoption of palliative sedations is very low(1.2%). Therefore, we recommended medical personnel to explain the pros and cons of life-sustaining medical care(such as NIV) to patients and their family while the patient remains consciousness, and use sedations appropriately for palliative purposes to avoid patient suffering.

Abstract: The objective of the present study was to investigate the characteristics of patients who received off-label us of non-invasive ventilator (NIV) therapy during 1 Aug., 2013 to 31 Dec., 2015(29 months in total). The electronic medical records of these patients were retrospectively reviewed and analyzed. Among the enrolled 449 patients, 326 are non-cancer patients (72.6%), and 123 are cancer patients (27.4%). The average age is 75.03 years (SD=13.97), average NIV period is 5.80 days (SD=6.03), average hospitalized period is 19.97 days (SD =15.42). For non-cancer patients, the percentage of “Do Not Resuscitate (DNR)” discussion (56.4% vs.73.2%; p=0.001), “Do Not Intubation (DNI)” (23.3% vs 43.9%; p<0.001), adoption of palliative sedations (1.2% vs. 44.7%; p<0.001), and death during hospitalization (27.9% vs.63.4%; p<0.001) are all significantly less than those of cancer patients. The percentage of adopting NIV therapy under unconsciousness among non-cancer patients is significantly higher than that of cancer patients (52.8% vs. 35.8%; p=0.001). The fatality rate among non-cancer patients who received off-label NIV therapy under unconsciousness is nearly 30%, and the adoption of palliative sedations is very low(1.2%). Therefore, we recommended medical personnel to explain the pros and cons of life-sustaining medical care(such as NIV) to patients and their family while the patient remains consciousness, and use sedations appropriately for palliative purposes to avoid patient suffering.