加護病房生命末期病人撤除氣管內管之經驗分析

Withdrawal of Endotracheal Tube for Patients at End-of-Life in Intensive Care Unit

10.6537/TJHPC.2015.20(2).2

馬瑞菊(Jui-Chu Ma)；鄭婉如(Wan-Ju Cheng)；李佳欣(Chin-Hsin Li)；林佩璇(Pei-Xuan Lin)；蘇珉一(Min-I Su)

加護病房 ； 生命末期 ； 撤除氣管內管 ； 安寧照護 ； Intensive Care Unit ； end of life ； withdrawal of endotracheal tube ； palliative care

安寧療護雜誌

20卷2期（2015 / 07 / 01）

120 - 132

繁體中文

研究目的：探討加護病房生命末期病患撤除氣管內管之經驗。材料與方法：採病歷回溯性調查設計，以內科加護病房2014年8月至2015年7月撤除氣管內管之個案作經驗分析，並以自擬結構性調查表進行資料收集及統計。結果：收案之20位撤除氣管內管個案中平均年齡70.15 (SD=18.69)歲、APACHE II為25.3(SD=8.01)分、召開家庭會議次數為2.7(SD=1.94)次。個案特性中僅一位為癌症末期，95%(n=19)為八大非癌重症末期， 所有病人在住院前均無DNR註記，撤除氣管內管至死亡的平均時間為63.13(SD=120.17)小時，撤除後有6人返家後往生，5人在加護病房往生，另5人下轉至病房在家屬陪伴中往生，其餘4人出院。結論：加護病房病情瞬息萬變，在過度醫療與如何讓病人能善終之間的抉擇，更有賴於醫療團隊對於緩和醫療的認知、態度與技能。面對醫療極限無法挽救的重症末期病患時，需掌握開啟家庭會議的時機，討論緩和醫療及死亡的議題，以維護重症病患善終之權利。對於撤除後轉出仍存活之病人必須透過與病房、居家之橫向連結，建立良好的交班制度方能貫徹病人選擇安寧之理念，拒絕無效的延命醫療。

Objectives: Our study aimed to investigate the withdrawal of endotracheal tube in Taiwan intensive care units (ICUs). Methods: This is a retrospective observational study. We include medical ICU patients treated with withdrawal of endotracheal tube from August 2014 to July 2015 in Mackay Memorial Hospital Taitung Branch. Results: The 20 cases of withdrawal of endotracheal tube had an average age of 70.15 (SD=18.69) years, APACHE II score of 25.3(SD=8.01) points, and number of family meetings of 2.7(SD=1.94) times. Among the reasons of withdrawal of endotracheal tube, one of them was a terminal cancer patient, and 95%(n=19) of them were in the final stage of eight non-cancerous critical illnesses. All patients did not write DNR order before hospitalization, and the average time of withdrawal of endotracheal tube until death was 63.13(SD=120.17) hours. After withdrawing endotracheal tube, six patients died after returning home, five patients died in the ICU, five patients were transferred to the ward and died in the companionship of family members, and the remaining four patients were discharged from hospital. Conclusion: In order to make better decision between excessive medical treatment and hospice care in ICU patients at the end of life, the critical care team need more awareness, attitudes and intensive work in palliative care. How to set family meeting regarding palliative care and death is an essential issue for patient approaching end of life. For those patients who still survive after withdrawal of endotracheal tube, they must be cared in the ordinary ward or home with the help of palliative care unit to ensure a peaceful demise.

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