使用適應支持型通氣於呼吸器脫離期病患之照護經驗

Difficult weaning from mechanical ventilator is an important clinical issue in the field of respiratory care for critically ill patients. The reasons for difficult weaning are usually related to intrapulmonary pathological processes or long-term course of disease. The duration of repeated weaning trials will prolong the patient's ventilation time. The longer of the patient on the ventilator, the possibility of successful weaning will decrease. In the same time, the consuming of medical resources will increase. Therefore, how to wean the ventilator-dependant patient as soon as possible in order to relocating the medical resources effectively is an important responsibility of respiratory therapist.
This patient was admitted in intensive care unit due to acute respiratory failure resulting from pneumonia. She was intubated and installed mechanical ventilation. After his condition was improved, weaning from the ventilator was tried for several times but failed. Twenty-nine days later, she was transferred to the respiratory care unit. Adaptive support ventilation was used as weaning mode in order to provide an automatic adaptation of the ventilator settings to patient's passive and active respiratory mechanics. Because of the persisted hemodynamic instability, infection, intestinal obstruction, malnutrition, and fluid and electrolytes unbalance, she was finally failed to wean from the ventilator. In this report, the course of respiratory care, the reasons of weaning failure, and the role of adaptive support ventilation in weaning trial of this patient will be discussed.