難治型顱內高壓病人接受目標體溫管理之醫病共享決策

Shared Decision-Making in Targeted Temperature Management for a Patient with Refractory Intracranial Hypertension

本文探討一位顱內出血併發難治型顱內高壓及體溫過高個案，於加護病房接受目標溫控治療之護理經驗。照護期間，個案雖接受多線降顱內壓藥物與外科手術，仍持續出現顱內壓升高及體溫過高情形，團隊運用整體性評估架構，對其生理、心理、家庭社會與靈性面向，進行全面評估，確立主要健康問題為顱內調適能力降低、體溫過高、決策衝突。針對難治型顱內高壓照護與體溫過高之臨床問題，醫療團隊依據實證建議實施目標溫控治療，並搭配組合式降溫策略，加強核心體溫調節與顱內壓變化之持續監測與管理，成功使核心體溫由38.2-39.0°C降至35.8-36.2°C區間，顱內壓由最高18-20 mmHg降至穩定於11 mmHg以下，顯示該策略具有良好的臨床成效。照護期間亦結合醫病共享決策方式，協助病家釐清不同治療選項與效益分析，促使治療共識之形成，未來建議定期舉辦目標溫控個案討論會，提升醫護人員對不同階段照護流程之熟悉度，並早期啟動出院規劃，強化重症病人長期照護資源連接，增進醫療團隊整合性落實全人照護品質。

This case report presents the intensive care experience of a patient with intracerebral hemorrhage complicated by refractory intracranial hypertension and hyperthermia, who underwent targeted temperature management (TTM). Despite receiving multiple lines of ICP-lowering medications and surgical interventions, the patient continued to exhibit elevated ICP and body temperature. A holistic assessment framework was employed to evaluate the patient’s physiological, psychological, social, and spiritual conditions, identifying key health issues: impaired intracranial adaptive capacity, hyperthermia, and decisional conflict. To address the clinical challenges, the multidisciplinary team implemented evidence-based TTM along with a multimodal cooling strategy. This comprehensive approach enabled effective control of ICP and body temperature, reducing ICP from 18-20 mmHg to below 11 mmHg and core temperature from 38.2-39.0°C to 35.8-36.2°C, demonstrating favorable clinical outcomes. Shared decision-making was also incorporated to facilitate understanding and consensus among the patient’s family regarding treatment options. Based on this experience, it is recommended to conduct regular TTM case reviews to enhance staff competence in various stages of care and to initiate early discharge planning. These strategies aim to strengthen long-term care integration and promote holistic patient-centered care in critical settings.