一位COVID-19重症病人合併急性呼吸窘迫症之加護經驗

Experience Caring for a Severe COVID-19 Patient With ARDS in the Intensive Care Unit

本篇描述照護一位中年男性感染新冠肺炎且快速惡化為重症之加護經驗，個案因疾病導致急性呼吸窘迫症候群，插管後使用呼吸器與體外循環維生系統，因屬新興呼吸道傳染性疾病特性而入住負壓隔離加護病房。由於病毒感染引起之呼吸衰竭與腎損傷，病人還須面對疾病預後未知的焦慮，以及與外界隔離。筆者照護期間為2020年4月5日至5月21日，以直接照護、筆談、肢體溝通、觀察、身體評估、查閱紀錄及診斷報告方式收集資料，對生理、心理、社會、靈性發展層面進行評估，確立其主要健康問題為：氣體交換障礙、感染、焦慮等問題。經提供個別性治療，監測生命徵象及使用體外維生系統，且由護理師、醫師及呼吸治療師組成拍痰團隊，改善個案的肺實質化及肺部塌陷問題，並成功脫離呼吸器；使用人形圖、白板畫圖的方式，教導個案身上管路留置目的；藉由手機視訊、通話等方式，取代傳統會客方式，讓個案可以與家人聯繫，改善焦慮與社交隔離問題，進而增加其治療配合度及信心。建議未來負壓隔離加護病房能增設雙向視訊裝置與電視，以達有效溝通與減輕病人焦慮目的；也期望藉由分享此照護經驗，能推廣人性化關懷照護落實於臨床實務，以提升隔離病人的照護品質。

The author's experience caring for a patient with COVID-19 whose condition deteriorated rapidly into a critical illness in the negative pressure room of the intensive care unit is described in this article. The onset of severe acute respiratory distress syndrome led this patient to receive endotracheal intubation with mechanical ventilation and subsequent extracorporeal membrane oxygenation for life support. He was isolated in the negative air pressure room in the intensive care unit for infection control for this emerging respiratory infectious disease. This patient was also confronted with emotional pressures arising from the general uncertainty regarding the progress of this novel disease and from being isolated from the outside world. The care period was from April 5th to May 12th, 2020. The data was collected through direct care, written conversations, physical communication, observation, medical record reviews, diagnosis reports, and nursing assessments of physical, psychological, social, and spiritual distress. The health problems of this patient were identified as gas exchange disorder, infection, anxiety, and other problems. Our chest physiotherapy team comprised nurses, physicians, and respiratory therapists. After administering individualized treatments, including monitoring vital signs and installing an external life support system, the lung consolidation and lung collapse problems of the patient improved, allowing the ventilator to be removed. To address the patient's psychological problems, we used a humanoid diagram and whiteboard drawing as communication tools to explain to the patient the reasons for and functions of the different tubes on his body to reduce his anxiety and maintain the safe use of these tubes. Moreover, bedside care was replaced by mobile phone video and phone calls, allowing the patient to communicate with family members, which reduced his isolation-related anxiety and enhanced his compliance with treatment and care protocols. This experience supports the benefit of installing two-way video devices and viewing monitors in negative pressure rooms in the ICU to facilitate effective communications between patients, patient family members, and the medical team to reduce patient-perceived anxiety and social isolation. This case report provides a reference demonstrating a patient-centered caring model for treating COVID-19 patients in the ICU.