一位低溫治療無效病人撤除維生醫療之加護經驗

Intensive Care Experience of a Patient Withdrawing Life-sustaining Treatment after Failing Therapeutic Hypothermia

10.29494/LN.202209_23(3).0010

金淑儀(Shu-I Chin)；王曉君(Hsiao-Chun Wang)；連如玉(Ru-Yu Lien)

急救復甦 ； 低溫治療 ； 醫病共享決策 ； 撤除維生醫療 ； cardiopulmonary resuscitation ； therapeutic hypothermia ； shared decision-making ； withdrawal of life-sustaining treatment

領導護理

23卷3期（2022 / 09 / 01）

134 - 149

繁體中文

本文描述一位舌癌個案於術後接受放射線治療，繼而發生呼吸困難行氣管插管術時心跳停止，經急救復甦、低溫治療終未果故撤除維生醫療的護理經驗。於2018年11月26日至12月8日運用Gordon評估確立有低溫治療導致之高危險性傷害、家人決策焦慮及照顧者預期性哀傷等健康問題。護理過程嚴防低溫合併症、提供病情說明減輕決策焦慮、抒發家人哀傷情緒。筆者深感適時而充足的醫療資訊如及時雨般助決策者於困境中找到出路，抉擇撤除維生醫療時刻方能從容篤定並降低傷痛。期望藉此經驗分享，提供臨床護理同仁作為「醫病共享決策」與生命末期關懷照護需求之參考。

This study describes a nursing experience of a tongue cancer patient who received radiation therapy after surgery and underwent dyspnea with endotracheal intubation, and followed by cardiac arrest, as well as the withdrawal of life-sustaining treatment after failing cardiopulmonary resuscitation and therapeutic hypothermia. The evaluation was based on Gordon's Eleven Functional Health Patterns and conducted from November 26 to December 8 in 2018, identified health issues include high-risk injury caused by therapeutic hypothermia, family decision anxiety, caregiver's anticipatory grief and so on. During the nursing process, strictly prevent hypothermia complications and the patient's condition was provided to ease decision-making anxiety and the sorrows of the family. The author feels by providing timely and adequate medical information for the decision makers will assist them to mitigate the pain when faced with the withdrawal life-sustaining treatment. It is hoped that by sharing this experience, this case can be served as a reference for the clinical nursing staff during the Shared Decision Making (SDM) between doctors and patients at the end of life caring requirement.

1. 連如玉,盧淑芬,王媛,金淑儀,熊道芬(2020)。加護病房護理人員生命態度與死亡因應自我效能之相關性探討。護理雜誌，67(5)，33-43。
   連結：
2. Bandini, J. I.(2022).Beyond the hour of death: Family experiences of grief and bereavement following an end-of-life hospitalization in the intensive care unit.Health,26(3),267-283.
3. Brooks, L. A.,Manias, E.,Nicholson, P.(2017).Communication and decision-making about end-of-life care in the intensive care unit.American Journal of Critical Care,26(4),336-341.
4. Casamento, A.,Minson, A.,Radford, S.,Mårtensson, J.,Ridgeon, E.,Young, P.,Bellomo, R.(2016).A comparison of therapeutic hypothermia and strict therapeutic normothermia after cardiac arrest.Resuscitation,106,83-88.
5. Downar, J.,Delaney, J. W.,Hawryluck, L.,Kenny, L.(2016).Guidelines for the withdrawal of life-sustaining measures.Intensive Care Medicine,42(6),1003-1017.
6. Fehnel, C. R.,Armengol de la Hoz, M.,Celi, L. A.,Campbell, M. L.,Hanafy, K.,Nozari, A.,White, D. B.,Mitchell, S. L.(2020).Incidence and risk model development for severe tachypnea following terminal extubation.Chest,158(4),1456-1463.
7. Panchal, A. R.,Bartos, J. A.,Cabañas, J. G.,Donnino, M. W.,Drennan, I. R.,Hirsch, K. G.,Kudenchuk, P. J.,Kurz, M. C.,Lavonas, E. J.,Morley, P. T.,O'Neil, B. J.,Peberdy, M. A.,Rittenberger, J. C.,Rodriguez, A. J.,Sawyer, K. N.,Berg, K. M.(2020).Part 3: Adult basic and advanced life support: 2020 American Heart Association Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care.Circulation,142(16, Suppl. 2),s366-s468.
8. Paré, A.,Joly, A.(2017).Oral cancer: Risk factors and management.La Presse Médicale,46(3),320-330.
9. Spoljar, D.,Curkovic, M.,Gastmans, C.,Gordijn, B.,Vrkic, D.,Jozepovic, A.,Vuletic, S.,Tonkovic, D.,Borovecki, A.(2020).Ethical content of expert recommendations for end-of-life decision-making in intensive care units: A systematic review.Journal of Critical Care,58,10-19.
10. Strojan, P.,Hutcheson, K. A.,Eisbruch, A.,Beitler, J. J.,Langendijk, J. A.,Lee, A. W. M.,Corry, J.,Mendenhall, W. M.,Smee, R.,Rinaldo, A.,Ferlito, A.(2017).Treatment of late sequelae after radiotherapy for head and neck cancer.Cancer Treatment Reviews,59,79-92.
11. Walker, A. C.,Johnson, N. J.(2019).Targeted temperature management and postcardiac arrest care.Emergency Medicine Clinics of North America,37(3),381-393.
12. 衛生福利部統計處（2021，8 月 16日）．109年國人死因統計結果。https://dep.mohw.gov.tw/DOS/lp5069-113-xCat-y109.html