鬱血性心臟病患者夜間通氣支持之出院計劃及居家呼吸照護

This is a congestive heart failure patient with respiratory failure。She was admittted five times within two years, and repeated intubated for three times. She was intubated again at this admission, in order to facilitate wean ventilator, tracheostomy was performed after one month intubation. However, she was weaker with hypercapnia in day time after she was weaned from ventilator and breathing with oxygen only all day; and it is hardly to condition the physical status. Therefore, she was supported with PACV mode (pressure assist control ventilation) via tracheostomy at night and maintain normal PaCO2, then she could eliminate sleep disorder breathing by reduce central sleep apnea episode。
Physical Reconditioning program including: limb strengthening exercise, wear oxygen walking, speaking training, secretion clearance. After three week nocturnal ventilator support and reconditioning, circulation of four limbs improved, her skin color below knee significantly changed from black to light brown。 Moreover her activity of daily living could improve from severe to moderate dependent, also the quality of life increased. Therefore, we thought nocturnal ventilator support combined with reconditioning program could delay deterioration of disease, and further enhance function level of living.