呼吸器脫離計畫對外科加護病房呼吸器留置時間之統合分析與應用

Effectiveness of the Weaning Protocol and Duration of Mechanical Ventilation in Surgical Intensive Care Units: A Meta-Analysis

本研究目的以系統性文獻回顧呼吸器脫離計畫實施，對外科加護病房呼吸器留置時間之效益。搜尋中英文之次級及初級資料庫共七個。納入文獻條件包括實施內容為呼吸器脫離計畫、外科加護病房病人；結果指標為呼吸器留置時間。排除條件為小兒科或呼吸照護中心；實施內容非呼吸器脫離計畫，或由電腦自動啟動呼吸訓練。共搜尋到234 篇文獻，納入4 篇研究進行統合分析；結果呈現實施計畫後，呼吸器留置時間的平均差為-35.33 小時，95% CI[-41.27,-29.39], p< .000及-1.25 天，95% CI[-1.35, -1.15], p < .000；住加護病房天數平均差-2.00 天，95%CI[-2.12,-1.88], p< .000。本院應用結果顯示能縮短呼吸器留置時間0.99 天，建議訂定專科屬性呼吸器脫離計畫、定期教育訓練與稽核，以提升計畫執行率，藉以縮短呼吸器留置時間。

The purpose of this study was to systematically review literature regarding the duration of mechanical ventilation and effectiveness of the weaning protocol in surgical intensive care units (SICUs). Seven Chinese and English secondary and primary databases were searched using the criteria of weaning protocol, SICU, and duration of mechanical ventilation. Studies on pediatric and respiratory care centers, nonweaning protocol, and computer-generated automatic breathing training were excluded. Among the 234 articles screened using the inclusion criteria, four were included in meta-analysis. Results of the duration of mechanical ventilation revealed a mean difference (MD) of 35.33 hours(95% confidence interval (CI)[-41.27, -29.39], p<.000), and 1.25 days (95%CI[- 1.35, -1.15], p<.000); SICU stay MD was 2.00 days (95%CI[-2.12, -1.88], p<.000). For improving the effectiveness of the weaning protocol, establishing specialist property for weaning protocol and regular in-service education and audits are crucial.